scholarly journals Comparison of Diagnostic Accuracy of Portal Serum Ascitic Albumin Gradient (SAAG) with Ascitic Fluid Total Protien (AFTP) Differentiating Portal Hypertension from Non-Portal in Patients with Ascites

2021 ◽  
Vol 15 (6) ◽  
pp. 1924-1926
Author(s):  
Salman Khan ◽  
Ihsan Ullah ◽  
Moeen ul Haq ◽  
Umar Badshah ◽  
Maryam Nazir
Keyword(s):  
Portal Hypertension ◽  
Serum Albumin ◽  
Diagnostic Accuracy ◽  
Ascitic Fluid ◽  
Total Protein ◽  
Ascites Fluid ◽  
P Value ◽  
Total Proteins ◽  
Local Data ◽  
Hospital Laboratory

Introduction: Although majority of the cases of ascites have cirrhosis, there are 15% patients where there is a non-hepatic cause of fluid retention like malignancy, congestive heart failure and tuberculous peritonitis. Ascites is the most common complication of cirrhosis that leads to hospital admission. Objective:To compare the diagnostic Accuracy of Serum Ascitic Albumin Gradient (SAAG) and Ascitic Fluid Total Proteins in patients with ascites by taking Ultrasound abdomen & Pelvis as gold standard. There are international studies on the accuracy of SAAG in determining cause of ascites but not much local data. Additionally, SAAG is not widely used in our setup. The results of this study will add to the existing knowledge and will help in the diagnosis and better management of these patients. Material & Methods: A cross sectional validation study was conducted in the department of General Medicine, DHQTH, Dera Ismail Khan from 29th April to 29th Oct, 2019. Diagnostic Ascitic fluid was aspirated from the peritoneal cavity and ascitic fluid was sent to hospital laboratory for total protein and albumin. Blood was taken at the same time and was send to the hospital laboratory for the serum albumin. SAAG was calculated by subtracting ascitic albumin value from the serum albumin value. Both, Ascitic fluid total protein and SAAG values was documented in the proforma. Ultrasound Abdomen & Pelvis was done on each patient with special instruction for radiologist to comment upon Portal Vein diameter and any changes in its diameter with respiration. Results: As per comparison Of SAAG with ultrasound in detecting ascites, sensitivity was 36.26%, specificity was 75%, PPV was 84.62%, NPV was 23.68% and accuracy was 44.35%. P Value was 0.299. As per comparison of AFTP with ultrasound in detecting ascites, sensitivity was 33.33%, specificity was 59.34%, PPV was 17.78%, NPV was 77.14% and accuracy was 53.91%. P value was 0.513. Conclusion:SAAG exhibits that patients with ascites fluid possess the basis of portal hypertension. Thus we have come to this conclusion that SAAG can effectively enhance the diagnostic value of ascites fluid tests and therefore its classification can be considered to be a novel standard in the analysis of ascites fluid. Keywords: Diagnostic Accuracy, Ascites Volume, Ascitic Albumin Gradient (SAAG), Ascitic Fluid Total Proteins (AFTP)

scholarly journals A comparative study of serum ascitic fluid albumin gradient with ascitic fluid total protein in evaluating the etiology of ascites

2019 ◽  
Vol 6 (4) ◽  
pp. 1259
Author(s):  
Manigandan Gopi ◽  
Mohamed Hanifah
Keyword(s):  
Diagnostic Accuracy ◽  
Ascitic Fluid ◽  
Total Protein ◽  
Alcoholic Cirrhosis ◽  
Diagnostic Procedures ◽  
P Value ◽  
Ascites Formation ◽  
Sensitivity Specificity ◽  
Insight Into

Background: The traditional method of classification of ascites by AFTP offers little insight into the pathophysiology of ascites formation and it has many drawbacks. In order to overcome it, the classification of ascites based on SAAG has emerged. Even SAAG has some draw backs like non correlation with ascites due to non-alcoholic cirrhosis and difficulty in identifying the ascites due to mixed etiology. This study is conducted to compare the diagnostic accuracies of SAAG and AFTP in identifying the pathophysiology of ascites.Methods: A total of fifty patients who were admitted with ascites were included in the study.  Ascitic fluid total protein and SAAG were calculated. They were classified on the basis of SAAG into High SAAG and Low SAAG and on the basis of AFTP into Transudate and Exudate. After the etiology of ascites evaluated by various diagnostic procedures, the sensitivity, specificity and diagnostic accuracy of SAAG and AFTP in identifying the pathophysiology of ascites calculated sepereately. The diagnostic accuracies of SAAG and AFTP were compared statistically.Results: The sensitivity of SAAG was found to be 86.84% and that of AFTP  60%. The specificity of SAAG was found to be 83.33% and that of AFTP was found to be 60%. The diagnostic accuracy of SAAG was found to be 86% and that of AFTP was found to be 60%. The diagnostic accuracy of SAAG and AFTP for individual etiologies of ascites were found and compared. SAAG was found to be superior to AFTP with a P value of <0.01 which was statistically significant.Conclusions: The sensitivity and specificity of SAAG was superior to AFTP in identifying the etiology of ascites.

Clinical usage of serum albumin to ascitic fluid albumin gradient and ascitic fluid total protein in pediatric ascites

2020 ◽  
Author(s):  
Wikrom Karnsakul ◽  
Paul Wasuwanich ◽  
Thammasin Ingviya ◽  
Pavis Laengvejkal ◽  
Alexandra Vasilescu ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Ascitic Fluid ◽  
Total Protein

Serum protein electrophoresis pattern in patients living with HIV: frequency of possible abnormalities in Iranian patients

2019 ◽  
Author(s):  
Zohreh Nozarian ◽  
Vahid Mehrtash ◽  
Alireza Abdollahi ◽  
Saloomeh Aeinehsazi ◽  
Atieh Khorsand ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Total Protein ◽  
Antiretroviral Treatment ◽  
Protein Electrophoresis ◽  
Cd4 T Cell ◽  
P Value ◽  
Treatment Status ◽  
Cell Counts ◽  
Significant Difference ◽  
Polyclonal Gammopathy

Background and Objectives: This prospective case-control study was conducted to evaluate abnormal serum protein electrophoresis (SPEP) patterns in patients living with human immunodeficiency virus (HIV) and its relation with disease severity markers and anti-retroviral treatment status. Materials and Methods: Thirty-seven HIV-positive patients and 24 healthy individuals were evaluated in the course of this study. The healthy HIV-negative individuals were selected as control group. Pregnant women, patients with malignancies, children, hepatitis B- and/or C-positive patients, those with a history of an autoimmune disease, or previous corticosteroid administration were excluded. SPEP—which detects serum levels of albumin, total protein, gammaglobulin—, CD4+ T-cell counts, viral load, and antiretroviral treatment status were assessed. Data were analyzed by SPSS™ software. Results: Twelve patients (32 percent) demonstrated polyclonal gammopathy on SPEP, while only 1 (4 percent) healthy individual had the same pattern (P-value = 0.007). No statistically significant connection between SPEP patterns and antiretroviral treatment status was observed (P-value > 0.05). Interestingly no statistically significant relationship between CD4+ T-cell counts and polyclonal gammopathy was discerned. No statistically significant difference was observed between the two groups with regards to serum albumin and total protein levels. The serum albumin to total protein percentage, serum gamma globulin to total protein percentage, and serum albumin to globulin ratio was compared between the groups and a statistically significant difference was observed. Conclusion: Polyclonal gammopathy on SPEP is common among HIV-infected patients. Moreover, the SPEP patterns cannot be used as an indication of a patient’s negative or positive response to treatment.

scholarly journals Ascitic fluid analysis with special reference to serum ascites cholesterol gradient and serum ascites albumin gradient

2017 ◽  
Vol 5 (2) ◽  
pp. 429 ◽  
Author(s):  
Anand Sankar Sastry ◽  
Subash Ch. Mahapatra ◽  
Vidyasagar Dumpula
Keyword(s):  
Diagnostic Accuracy ◽  
Ascitic Fluid ◽  
Total Protein ◽  
High Sensitivity ◽  
Cost Effective ◽  
Clinical Problem ◽  
Malignant Ascites ◽  
Diagnostic Efficacy ◽  
Fluid Analysis ◽  
Sensitivity Specificity

Background: Ascites being a common clinical problem with a vast spectrum of etiologies, less expensive and widely available biochemical parameters are required to differentiate ascites which can correlate with pathogenesis and pin point towards an etiology with high sensitivity and significant accuracy. Aims of the study were to determine the sensitivity, specificity and diagnostic efficacy of serum ascites albumin Gradient (SAAG) and that of ascitic fluid total protein (AFTP), evaluating their diagnostic role in identifying the etiology of ascites, to determine the diagnostic efficacy of Ascitic fluid cholesterol and serum ascites cholesterol gradient (SACG) in diagnosis of malignant ascites.Methods: In this study, 100 patients of ascitis were evaluated for ascitic fluid total protein, albumin, cholesterol, SAAG and SACG along with ultrasound and other required investigations.Results: Sensitivity, Specificity, and Diagnostic accuracy of SAAG for Portal hypertension were 97%, 85%, 96% respectively, whereas those of AFTP for exudative/transudative ascitis were 78.5%, 66%, 68% respectively. Ascitic fluid cholesterol and Mean SACG were significantly elevated in malignant ascites when compared with Non-Malignant Ascitis with p=0.0001. Similarly with a cut off level of 70mg% and 54 mg%, Ascitic fluid cholesterol and Mean SACG are having diagnostic accuracy of 90% and 93% respectively.Conclusions: SAAG is much more superior to AFTP in differential diagnosis of Ascitis. Ascitic fluid cholesterol and Mean SACG are simple and cost effective methods to separate malignant ascitis from non-malignant causes even in small centres with limited diagnostic facilities.

scholarly journals Clinicopathological correlation of serum ascites albumin gradient with ascitic fluid total protein in patients of ascites with portal hypertension attending a tertiary care hospital in Eastern Bihar, India

2017 ◽  
Vol 4 (3) ◽  
pp. 842 ◽  
Author(s):  
Shanker Suman ◽  
Divya Jyoti ◽  
Pramod Kumar Agrawal ◽  
Bijoy Kumar Bhattacharya
Keyword(s):  
Portal Hypertension ◽  
Ascitic Fluid ◽  
Total Protein ◽  
Protein Concentration ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Total Protein Concentration ◽  
Provisional Diagnosis

Background: The level of ascitic fluid total protein (AFTP) is used to differentiate between transudative and exudative ascites. Ascites patients having portal hypertension are considered to be transudative in nature. The traditional transudate/exudate system of ascitic fluid classification based on ascitic fluid total protein concentration is sometimes misleading in patients of ascites with portal hypertension. Now a days SAAG (serum ascites albumin gradient) has become more acceptable in differentiating patients presenting with ascites due to portal hypertension. The objective of this prospective study was to correlate serum ascites albumin gradient with ascitic fluid total protein in patients of ascites having portal hypertension.Methods: 100 cases of ascites are selected randomly. All the provisional diagnosis are confirmed with the help of different biochemical, pathological and radiological investigations.Results: SAAG (≥1.1gm/dl) was more sensitive and specific (94% and 90% respectively) than ascitic fluid total protein concentration of <2.5 gm/dl (78% and 50% respectively) in detecting portal hypertension and had higher positive and negative predicative values (97% and 82% respectively) compared to AFTP concentration (85% and 38% respectively).Conclusions: Considering the advantages of measuring the serum-ascites albumin gradient in illuminating the pathogenesis of ascites and the ease with which this test can be done, it is suggested that this parameter should replace the traditional parameter of ascitic fluid total protein level in the routine analysis of ascites fluid and classification of ascites.

scholarly journals The Role of Ascitic Fluid Viscosity in the Differential Diagnosis of Ascites

2010 ◽  
Vol 24 (4) ◽  
pp. 255-259 ◽  
Author(s):  
Huseyin Savas Gokturk ◽  
Mehmet Demir ◽  
Nevin Akcaer Ozturk ◽  
Gulhan Kanat Unler ◽  
Sevsen Kulaksizoglu ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Ascitic Fluid ◽  
Total Protein ◽  
Small Sample ◽  
Fluid Viscosity ◽  
Serum Total Protein ◽  
Bacterial Peritonitis ◽  
The Mean ◽  
Sensitivity Specificity

BACKGROUND: Ascites is defined as the pathological accumulation of fluid in the peritoneal cavity. It is the most common complication of cirrhosis, which is also the most common cause of ascites. Viscosity is a measure of the resistance of a fluid to deform under shear stress. Plasma viscosity is influenced by the concentration of plasma proteins and lipoproteins, with the major contribution from fibrinogen. To our knowledge, the viscosity of ascitic fluid has not yet been studied.OBJECTIVE: To evaluate the role of ascitic fluid viscosity in discriminating between ascites due to portal hypertension-related and nonportal hypertension-related causes, and to compare results with the serum-ascites albumin gradient (SAAG).METHODS: The present study involved 142 patients with ascites presenting with diverse medical problems. Serum total protein, albumin, glucose, lactate dehydrogenase (LDH) levels and complete blood count were obtained for all subjects. Paracentesis was performed routinely on admission and all ascitic fluid samples were evaluated by manual cell count with differential, ascitic fluid culture and biochemistry (total protein, albumin, glucose and LDH). Cultures of ascitic fluid were performed at bedside in all patients using blood culture bottles. Ascitic fluid viscosity was measured in a commercially available cone and plate viscometer.RESULTS: Of the 142 patients studied, 34 (24%) had an SAAG of 11 g/L or less, whereas 108 (76%) had an SAAG of greater than 11 g/L. Sex and mean age did not differ significantly between the two groups (P>0.05). Serum total protein, albumin, glucose, LDH levels, leukocyte count, ascitic fluid glucose levels and ascitic fluid leukocyte counts were similar in both groups, with no statistically significant relationship detected (P>0.05). However, the mean (±SD) ascitic fluid total protein (0.0172±0.1104 g/L versus 0.043±0.011 g/L), albumin (0.0104±0.0064 g/L versus 0.0276±0.0069 g/L) and LDH (102.76±80.95 U/L versus 885.71±199.93 U/L) were found to be higher in patients with an SAAG of 11 g/L or less than in those with an SAAG of greater than 11 g/L (P<0.001). The mean ascitic fluid viscosities were 0.86±0.12 centipoise (cP) and 1.22±0.25 cP in patients with an SAAG greater than 11 g/L and an SAAG of 11 g/L or less, respectively (P<0.001). Although ascitic fluid infection was detected in 35 patients (24.6%) (19 patients with spontaneous bacterial peritonitis, seven patients with culture-negative neutrocytic ascites, three patients with monobacterial non-neutrocytic bacterascites and six patients with secondary bacterial peritonitis), no significant effect on ascitic fluid viscosity was detected. Multiple linear regression analysis revealed that ascitic fluid total protein, albumin and LDH levels were independent predictors of ascitic fluid viscosity (P<0.001). The sensitivity, specificity, and positive and negative predictive values of ascitic fluid viscosity for the discrimination between ascites due to portal hypertension-related and nonportal hypertension-related causes according to the SAAG were determined by receiver operating characteristic analysis. Regarding the cut-off value of 1.03 cP, ascitic fluid viscosity measurement had a high sensitivity, specificity (98% and 80%, respectively), and positive and negative predictive value (79% and 94%, respectively) for the etiological discrimination of ascites.CONCLUSION: The measurement of ascitic fluid viscosity correlates significantly with SAAG values. In view of its simplicity, low cost, small sample volume requirement and allowance for measurement in previously frozen samples, measurement of ascites viscosity could be useful for the accurate and rapid classification of ascites.

scholarly journals Plasma Proteins in Enterica Serovar Typhi patients in Northern Sudan

2016 ◽  
Vol 5 (2) ◽  
Author(s):  
Nagah A.A.Mohamed ◽  
Mohieldin Omer
Keyword(s):  
Serum Albumin ◽  
Total Protein ◽  
Plasma Proteins ◽  
Albumin Level ◽  
P Value ◽  
Serum Globulin ◽  
Serum Total Protein ◽  
Significant Difference ◽  
G Ratio ◽  
Protein Serum

Background: The study entailed a quantitative assessment of serum total protein, albumin, globulin, and albumin.Method: globulin ratio in individuals who diagnosed positively with typhoid fever and detection any alteration in plasma protein in receptiveness to typhoid titers. One hundred positively diagnosed with typhoid infection mean age (41.5 ± 2.1) years on zero day treatments. In addition to healthy one hundred individuals mean age (42.9 ± 1.9) years were recruited in this study.Results: There were significant difference  P. value = 0.000   in total protein, serum albumin, serum globulin and A/G ratio for typhoid positive and negative,  mean (8.4±0.01,6.8±0.06), (3.5±0.01, 4.1±0.03), (4.9±0.01, 2.8±0.06), (0.7 ± 0.003, 1.5 ± 0.02) respectively. No significant difference, P. value was 0.632, 0.832 and 0.760 serum total protein (7.5 ± 0.92, 7.6 ± 0.79) serum albumin (3.8 ± 0.38, 3.8 ± 0.37) and serum globulin (3.8 ± 0.16, 3.9 ± 0.16) for males and females respectively. Also no significant difference, P. value was 0.11, 0.60, and 0.06 serum total protein (8.4 ± 0.01, 8.4± 0.02) serum albumin (3.5 ± 0.01, 3.5 ± 0.01) and serum globulin (5.0 ± 0.01, 4.9 ± 0.01) for titer 1/160 and titer 1/320.Conclusion: Low albumin level and hypoglycemia should be surveillant when anti typhoid pharmaceutical commenced.Key words: Plasma Proteins, Enterica Serovar Typhi, Sudan

scholarly journals Extracorporal modified ascitic fluid reinfusion in treatment of resistant ascites in liver cirrhosis

2017 ◽  
Vol 176 (3) ◽  
pp. 32-37
Author(s):  
I. E. Onnintsev ◽  
S. Ya. Ivanusa ◽  
A. V. Khokhlov ◽  
A. A. Sokolov ◽  
A. V. Yankovskiy
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Blood Plasma ◽  
Ascitic Fluid ◽  
Intravenous Infusion ◽  
Sodium Excretion ◽  
Albumin Level ◽  
New Method ◽  
Diuretic Resistance ◽  
Made In

OBJECTIVE. The aim of the study was to estimate the efficacy of new method of reinfusion of extracorporeal modified ascitic fluid in therapy of diuretic resistance ascites in patients with liver cirrhosis and portal hypertension syndrome. MATERIAL AND METHODS. An analysis of treatment was made in 83 patients, who underwent laparocentesis and ascitic fluid evacuation. The patients were divided into two groups. Laparocentesis and fractional evacuation of ascitic fluid were carried out for the patients of the first group (n=40). This procedure was followed by intravenous infusion of 25 % albumin (10 g of albumin on each 2 litres of removed fluid) in order to make up losses of protein. Laparocentesis and ascitic fluid evacuation with following extracorporal processing and reinfusion were performed for the second group of patients (n=43). RESULTS. There was noted an increase of day diuresis from (620,0 ± 110,0) ml to (2,2 ± 0,4) l compared with the first group from (780 ± 80) ml to (1,2 ± 0,5) l and rise of sodium excretion (132 ± 7) mmol/l compared with the first group - (120 ± 6) mmol/l. An average molecular peptide concentration was decreased in blood plasma to (0,254 ± 0,098) units in the second group and it counted (0,298 ± 0,045) units in the first group. CONCLUSIONS. Reinfusion of extracorporeal modified ascitic fluid was more effective than conventional correction of albumin level and electrolytes disturbances against a background of ascitic fluid evacuation.

scholarly journals Evaluation of SDS-Polyacrylamide gel electrophoresis and immunostrip technique for detection of Tobacco mosaic virus and Cucumber mosaic virus in IRAQ

2011 ◽  
Vol 5 (2) ◽  
pp. 85-94
Author(s):  
Rakib A. Al-Ani ◽  
Mustafa A. Adhab
Keyword(s):  
Tobacco Mosaic Virus ◽  
Cucumber Mosaic Virus ◽  
Mosaic Virus ◽  
Positive Reaction ◽  
Total Protein ◽  
Polyacrylamide Gel Electrophoresis ◽  
Protein Band ◽  
Polyacrylamide Gel ◽  
Total Proteins ◽  
Winter Squash

his study was carried out to evaluate the efficiency of electrophoresis on SDS- poly acrylamide slap gel and immunostrip techniques for detection of Tobacco mosaic virus (TMV, genus Tobamovirus) and Cucumber mosaic virus (CMV, genus Cucumovirus, family Bromoviridae), compared with symptoms on diagnostic plants for the two viruses. The results obtained showed that the two methods were effective. The analysis of samples of purified CMV, total proteins from infected cucumber plants, and extracts from infected plants with or without chlorophyll, by electrophoresis on 10% polyacrylamide slap gel containing 0.1% SDS showed two bands of 24 and 26 kd in size, and absent in samples of total protein or extracts of healthy plants. These two proteins represent the coat protein (CP) of CMV. In addition, one 18 kd protein band appeared on SDS- polyacrylamide gel profile which represent the CP of TMV, when samples of purified virus, total protein of infected plants, and plant extracts with or without chlorophyll were analyzed. This band was absent in similar samples from healthy plants. The test of immunostrip specific for CMV showed positive reaction with extracts from melon, cucumber, winter squash, and zucchini infected plants. Similarly, a positive reaction with immunostrip specific for TMV appeared with extracts from tobacco, tomato infected with TMV. No reaction was obtained with healthy plants extract. These results were similar to those obtained from indicator plants for the two viruses.

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