Diagnostic Accuracy of Serum Ascites Albumin Gradient (SAAG) with Ascitic Fluid Total Protein (AFTP) in Determining the Etiopathogenesis of Ascites

Introduction: The differential diagnosis of ascites remains difficult in clinical practice due to its varied etiopathogenesis. The serum-ascites albumin gradient (SAAG) is a better way to classify ascites than the total protein concentration of the fluid. We undertook the present study to assess the serum ascetic fluid albumin gradient (SAAG) in ascites cases and to compare its usefulness in determining the cause of ascites with the ascitic fluid total protein (AFTP) levels. Material and Methods: A total of 102 patients who had no prior etiology diagnosis of ascites were recruited. Participants had abdominal USG and CT scans to determine the presence of ascites and concurrently obtained ascitic fluid and blood samples, testing them for total protein, and serum albumin. We analysed serum albumin, ascitic fluid albumin, total protein, and the serum-ascitic fluid albumin gradient. Results: The commonest cause was cirrhosis (56.86%), followed by congestive cardiac failure (CCF) (18.62%), TB ascites (15.68%). SAAG levels were significantly associated with cirrhosis and congestive cardiac failure. SAAG has a sensitivity, specificity, PPV, NPV and accuracy of 86.22%, 85.78%, 95.36%, 67.12%, and 88.34% respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SAAG in relation to AFTP were all 65.74%, 62.32%, 32.76%, 86.20%, and 63%, respectively. Conclusion: SAAG was more sensitive and specific in determining the underlying pathophysiology of ascites. Comparison of SAAG and AFTP’s diagnostic accuracy revealed that SAAG significantly outperformed AFTP.