The Role of Serum Ascites Albumin Gradient in the Differential Diagnosis of Ascites.
AJTES Vol 6, No 1, January 2022
Dede et al


diagnostic paracentesis
albumin gradient
cirrhotic ascites
malignant ascites

How to Cite

Dede, H., Roshi, R., Bode, R., Roshi, E., & Basho, J. (2022). The Role of Serum Ascites Albumin Gradient in the Differential Diagnosis of Ascites. Albanian Journal of Trauma and Emergency Surgery, 6(1), 933-938.


Introduction: Ascites is of Greek derivation (“askos”) and refers to a bag or sack. The word is a noun and describes pathologic fluid accumulation within the peritoneal cavity. Orientation in finding or excluding portal hypertension through examination of ascitic fluid is the first step towards an accurate diagnosis.

Material and Methods: The aim of this study was to evaluate the role of SAAG (Serum Ascites Albumin Gradient) in the differential diagnosis between cirrhotic and malignant ascites. The SAAG is obtained by subtracting the value of serum albumin, the value of ascites albumin (from samples to be taken on the same day) and is a reflection of hepatic sinusoidal pressure.

Result: All ascitic fluids were analyzed on the laboratory parameters of ascitic albumin values and at the same time serological albumin through the blood was taken for analysis on the same day as the diagnostic paracentesis. The value of SAAG was calculated for each patient between their two groups: 64 patients with cirrhotic ascites and 8 patients with malignant ascites. Higher SAAG values were found in the group of patients with hepatic cirrhosis (2.02 ± 0.42) compared to the group of patients with malignant pathology (0.68 ± 0.19).

Conclusion: This prospective study showed statistically significant differences (p <0.0001) between cirrhotic ascites and malignant ascites in terms of SAAG, emphasizing the important role of diagnostic paracentesis and in particular the SAAG in the differential diagnosis of ascitic fluid, in accordance with cut-off values ≥1.1 g / dl referring to ascites from portal hypertension, which suggests a nonperitoneal cause of ascites.
Dede et al


Fede G, D'Amico G, Arvaniti V, et al. Renal failure and cirrhosis: a systematic review of mortality and prognosis. J Hepatol. 2012 Apr. 56(4):810-8.

History: Liver & Ascites, University of Washington, Department of Medicine, Advanced Physical Diagnosis Learning and Teaching at the Bedside, Edition 1

Mark Feldman, Lawrence Friedman, Lawrence Brandt: Sleisenger and Ford tran’s Gastrointestinal and Liver Disease Ninth Edition, 3rd May 2010.

The Merck Manual of Diagnosis and Therapy, 17th Edition 1999 (Centennial Edition) 17th Edition by Mark H. Beers (Editor), Robert Berkow (Editor)]

Yamada's Textbook of Gastroenterology, Sixth Edition. Edited by Daniel K. Podolsky, Michael Camilleri. J. Gregory Fitz, Anthony N. Kalloo, Fergus Shanahan, and E Timothy C. Wang. © 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.2087-2090}

Younas M, Sattar A, Hashim R, Ijaz A, Dilawar M, Manzoor SM, Ali A, Khan FA. Role of serum-ascites albumin gradient in differential diagnosis of ascites. J Ayub Med Coll Abbottabad. 2012 Jul-Dec; 24(3-4): 97-9. PMID: 24669623.

Hoefs JC. Serum protein concentration and portal pressure determine the ascitic fluid protein concentration in patients with chronic liver disease. J Lab Clin Med 1983; 102:260.

Henriksen JH. Colloid osmotic pressure in decompensated cirrhosis. A ‘mirror image’ of portal venous hypertension. Scand J Gastroenterol 1985; 20:170.

Pare P, Talbot J, Hoefs JC. Serum‐ascites albumin concentration gradient: a physiologic approach to the differential diagnosis of ascites. Gastroenterology 1983; 85:240.

Hoefs JC. Globulin correction of the albumin gradient: correlation with measured serum to ascites colloid osmotic pressure gradients. Hepatology 1992; 16:396.

T. N. Dubey, Shyam Dawane, Diagnostic Value of Serum Ascites Lipid Gradients in Patients with Ascites, International Journal of Contemporary Medical Research, September 2016, ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV: 50.43 | Volume 3 | Issue 9 | pg:2572-2577

Angeleri A, Rocher A, Caracciolo B, Pandolfo M, Palaoro L, Perazzi B. New Biochemical Parameters in the Differential Diagnosis of Ascitic Fluids. Gastroenterology Res. 2016 Feb; 9(1):17-21. doi: 10.14740/gr700w. Epub 2016 Mar 8. PMID: 27785319; PMCID: PMC5051108.

Rector WG Jr, Reynolds TB. Superiority of the serum ascites albumin difference over the ascites total protein concentration in separation of “transudative” and “exudative” ascites. Am J Med. 1984; 77:83-85

Prieto M, Gómez-Lechón MJ, Hoyos M, et al. Diagnosis of malignant ascites. Comparison of ascitic fibronectin, cholesterol, and serum-ascites albumin difference. Dig Dis Sci. 1988; 33:833-838.

E. E. L. Ekpe, A. J. Omotoso. The Relevance of Ascitic Lactate Dehydrogenase (LDH) and Serum Ascites Albumin Gradient (SAAG) in the Differential Diagnosis of Ascites among Patients in a Nigerian Hospital, British Journal of Medicine & Medical Research 8(3): 211-219, 2015, Article no. BJMMR.2015.441 ISSN: 2231-0614, pg. 211-219

Hoefs JC. Increase in ascites white blood cell and protein concentrations during diuresis in patients with chronic liver disease. Hepatology. 1981; 1: 249-254.R

Ginès Pere, Angeli Paolo, Lenz Kurt, Møller Søren, Moore Kevin, Moreau Richard, Merkel Carlo, Larsen Helmer, Bernardi Mauro, Garcia-Tsao Guadalupe, Clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis, EASL: European Association for the Study of the Liver, Journal of Hepatology 2010 vol. 53j 397–417

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