Usefulness of serum-ascites albumin gradient and fluid cholesterol determination in the differential diagnosis of ascites in Ivorian hospitals

The aim of this cross-sectional study was to compare serum-ascites albumin gradient (SAAG), serum-ascites protein gradient (SAPG) and cholesterol in ascitic fluid to Rivalta test and total protein in the ascitic fluid (TPA) to assess their diagnostic value in the classification of transudative and exudative ascites. The study examined 98 patients suffering from ascites recruited at university teaching hospitals in Abidjan. The diagnostic concordance between SAAG and Rivalta test and between SAAG and TPA was moderate (69% and 73%, respectively), while it was better between Rivalta test and TPA (88%). Results showed a higher sensitivity of SAAG (86.8%), with low specificity (40%). Cholesterol concentrations in the ascitic fluid provided the best diagnostic accuracy in the classification of ascitic fluids into exudates and transudates, with a sensitivity of 64.2% and a specificity of 86.7% (threshold value, 0.183 g/L). Given the high sensitivity of SAAG, fluid cholesterol and SAAG should be associated for a better differential diagnosis of ascites.