Study Of Diagnostic Significance Of Serum Lipid Gradients (SALG) In Differentiation Of Ascites From Liver

Aims: To study the significance of serum ascites lipid gradient (SALG) for total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol and VLDL cholesterol in differentiation of ascites due to cirrhosis of liver and ascites due to malignancy and tuberculosis. Material and methods: A study on 50 patients admitted at R.N.T. Medical college and MBG Hospital Udaipur admitted with ascites was carried out.The patients were classified as cirrhotic , tubercular and malignant on the basis of history, physical examination, USG and biochemical and cytological investigations. Biochemical examination of ascitic fluid for protein , albumin , cholesterol , LDL, HDL, VLDL, and triglyceride was estimated.. SALG was calculated by subtracting serum total cholesterol, triglyceride, VLDL, HDL. And LDL from ascitic cholesterol, triglyceride, VLDL, HDL and LDL respectively. Results: 32% of cases belonged to age group 41-50years.A male predominance was observes in the study with a ratio of 16:9. Maximum incidence of malignant ascites was observed in the age group of 41-50 years and more than 50 years. In all patients of ascites belonging to group of cirrhosis serum lipid profile was found lower than the patients of malignancy and tuberculosis and value of ascetic fluid lipid profile for total cholesterol, triglyceride, HDL cholesterol, VLDL cholesterol, and LDL cholesterol were also low. Values were highly significant in cirrhosis and malignant group ( C Vs M< 0.001) and cirrhosis and tuberculosis group (C Vs T <0.001), while it is not significant between malignant and tubercular group. Statistical analysis shows that the value of SALG for cholesterol, triglyceride, VLDL cholesterol, was significant between cirrhotic and malignant group (C Vs M<0.005) and highly significant between cirrhotic and tubercular group ( C V T <0.001) . SALG for HDL cholesterol was highly significant between cirrhotic and malignant group ( C Vs M <0.001) and cirrhotic and tubercular group ( C Vs T <0.001) while SALG for LDL cholesterol was significant between cirrhotic and malignant group ( C Vs M <0.05) and cirrhotic and tubercular group ( C Vs T ,0.05). Conclusion: Measurement of serum ascites lipid gradient can be used as alternate and additive to serum ascites albumin gradient in differential diagnosis of ascites.