Ola Alkharfan*, Hassan Zaizafoun, Daad Daghman
Background: Abdominal paracentesis with appropriate fluid analysis is considered the most rapid and cost-effective method of diagnosis the etiology of ascites.
Objective: The aim of this study is to examine the diagnostic value of ascites fluid cholesterol levels for differentiating between various etiologies of ascites.
Materials and methods: An analytic descriptive study was conducted in adult patients with a diagnosis of ascites. They are selected from gastroenterology department, Tishreen University Hospital between April 2021 and April 2022.
Results: A total of 142 patients, 84 males (59.2%) and 58 females (40.8%) were included in the study. Portal hypertension related ascites represented the most frequent pathophysiology of ascites (47.8%), followed by non-portal hypertension (43.7%) and mixed ascites (8.4%). There were significant differences between various etiologies of ascites regarding cholesterol levels in which high levels were observed in tumors (72.68 ± 32.7), followed by non-related portal hypertension (50.80 ± 7.8), and mixed ascites (43.41 ± 32.12), p:0.0001. Additionally, levels of SAAG were different significantly according to the etiology of ascites, in which high levels were found in portal hypertension related ascites (2.06 ± 0.4), followed by heart failure (1.95 ± 0.4), and cirrhosis (1.66 ± 0.5), p:0.0001. The mean value of serum ascites cholesterol gradient was higher in cirrhosis (92.57 ± 24.5) versus (63.78 ± 38.9) in tumors, p:0.0001. Serum ascites cholesterol gradient was significantly higher in portal hypertension (89.73 ± 24.9) versus (58.64 ± 41.2) in non-portal hypertension, p:0.001. In portal hypertension related ascites, sensitivity and specificity of cholesterol were 85.19% and 77.41% respectively, whereas sensitivity and specificity of SAAG were 91.17% and 69.35% respectively. Using of combination cut off for: Cholesterol <45 mg/dL and SAAG ≥ 1.1 led to specificity 91.93%. In non-portal hypertension related ascites, sensitivity of cholesterol was 77.41%, whereas specificity of SAAG was 91.17%. Combination of Cholesterol <45 mg/dL with SAAG ≥ 1.1 led to specificity 100%.
Conclusion: The current study demonstrated that cholesterol (cutoff 45 mg/dL) has suitable diagnostic value in distinguishing between portal from non-portal hypertension etiologies for ascites and also help in addition to atypical cells analysis in distinguishing between malignant from non-malignant ascites (cutoff 75 mg/dL). So we should routinely determine this simple and cost-effective measure in all new-onset ascites and in all patients with portal hyper tension ascites who do not respond to treatment because these patients maybe have mixed ascites.
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