Evaluation of the performance of biochemical ratios and albumin’s gradient in the etiological exploration of ascitic fluid Performance of biochemical ratios & albumin gradient in ascitic fluid exploration

Abstract

Introduction

Biochemical exploration of effusion fluids plays a crucial role in the diagnosis of underlying pathologies. This study aimed to evaluate the performance of biochemical ratios and the albumin gradients in the diagnostic process of ascitic fluids.

Methods

The study was prospective, involving 56 samples from ascitic patients. For each patient, five biochemical parameters (glucose, protein, albumin, LDH, and total amylase) were performed in ascites and plasma samples. The ascites/plasma protein, LDH ratios, and serum-ascites albumin gradients (SAAG), were calculated to evaluate their diagnostic relevance.

Results 

Twenty-eight adult patients presenting ascites were included in this study,18 women (64.28%) and 10 men (35.71%) with an M/F sex ratio of 0.55. The most efficient parameters to distinguish the transudate/exudate concept were: Ascitic proteins (p =0.01), ascitic/plasma proteins (p =0.004), ascitic LDH (p =0.011), ascitic/plasma LDH ratio (p =0.013), ascitic albumin (p = 0.012), ascitic albumin/plasma ratio (p = 0.002) and ascitic glucose/plasma ratio (p = 0.02). A threshold of 14 g/L of Albumine had a better positive predictive value than a threshold set at 20 g/L (73 vs 46%). The sensitivity, specificity, diagnostic efficiency, and positive and negative predictive values for SAAG were 100%, 64%, 78%, 64%, and 100% respectively, and for the modified Light’s criteria 78%, 86%, 82%, 80%, and 82% which had better diagnostic efficiency and specificity than the classic Light’s criteria with the respective comparative value 82 vs 78% and 86 vs 57% but less sensitivity (78 vs 100%). The criteria H20-30, H25, and TAL had good diagnostic efficiency with 75%, 75%, and 78% respectively.

Conclusion 

The integration of biochemical ratios and the albumin’s gradient significantly improves the differential diagnosis of ascites. It is essential to promote the use of these parameters in clinical practice to improve the treatment of patients with ascites