Category: Lipids/CV Health


Monday, Apr 8
1:00 AM – 2:00 AM

Objective :

Serum albumin ascites gradient (SAAG)  is usually used to differentiate transudate from exudate, but not a good test to differentiate malignant ascites from other aetiologies like tubercular peritonitis. Alternate screening test is needed for differentiating ascites due to malignancy from tubercular peritonitis.We attempted lipd and protein gradient from ascitic fluid with serum to differentiate various types of ascites.

Methods :  The study was conducted on 60 patients with ascites  admitted in Internal Medicine Department. All patients underwent abdominal paracentesis, fluid samples were sent for analysis.Data was entered in excel sheet and anlysed using SPSS statstics software.Oneway ANOVA, Shapiro-wilk test of normailty were used.ROC curve was used to define cutoff value for significance.

Results :

 Serun ascitic protein Gradient (SAPG) and Serum Ascitis Albumin Gradient ( SAAG) had over all statistical significance to differentiate transudative and exudtaive ascitis, but no significance between malignancy and tubercular ascites.ROC-curve analysis showed that similar to SAAG, SALG (LDL) had a sensitivity of 90 in differentiation of cirrhosis and non-cirrhotics. However specificity is higher for SAAG (77.5) when compared to SALG (LDL) (52.5). Similarly SAPG in present study revealed a sensitivity of 80 and specificity of 87.5 with a cut-off value of greater than 4. ROC-curve analysis in the present study to differentiate malignancy from non-malignancy had revealed that SAPG has higher AUC. With a cut-off value of less than or equal to 4, SAPG has higher sensitivity (100) when compared to SAAG However Ascitic fluid and Serum HDL cholesterol had a statistical significance (<0.05) between malignancy and tubercular ascites.

Discussion :

 The present study is unique in nature in considering serum ascites total protein gradient for differentiation of ascites and also included mixed ascites  Previous studies conducted in patients on peritoneal dialysis, a three pore concept was formulated for the principle for mechanism of transport of solute through peritoneum. Peritoneal inflammation might have lead to opening of small pores whereas peritoneal malignancy have lead to opening of opening of both small and large pores.HDL lipoproteins are slightly larger than the albumin and gamma globulins. This could possibly explain the statistical difference of HDL cholesterol levels in ascitic fluid betwee malignancy and tuberculosis observed in the present study.

Conclusion : With a cut-off value of  SAPG of 4 is one of better screening test in differentiation of cirrhosis with non-cirrhotics.  HDL cholesterol levels in ascitic fluid appears to be a valuable marker in differentiation of malignancy and tuberculosis


Mukhyaprana MANURU.. Prabhu

KMC Manipal, MAHE
Manipal, Karnataka, India

Current designation: Professor of Medicine & Unit head KMC Manipal, since March 2010
Working as Academic coordinator for international medical student exchange Maastricht University, Netherlands
Voluntary faculty: Asst Professor of family medicine, University of Kentucky USA
Special interest: Immunology, Lipidology, Infectious diseases, Diabetes, Hypertension Medical education
Life Member of API, IMA, Critical care society of India, Member of American Academy of Clinical endocrinologists (AACE), Member American College of Physicians (ACP)
Research: Publications: International indexed: 90 total 113
National: 13
State/non-indexed :10
Good Teacher award KMC Manipal 2014,
Professional commitment from American college of Physicians Indian chapter 2018
Scientific editor: Journal of Medicine use in developing countries Peer reviewer Journal of General Medicine published by Blackwell synergy, Gynecologic and obstetric investigations journal published by Karger Publication, BMJ Case reports BMJ publications
Principle investigator in 9 multinational clinical trials in Diabetes, ITP, SLE, Hyperlipidemia Coinvestigator in 20 trials on Diabetes, Hypertension, Infectious disease, OA
Conference presentations: International .Presented papers in International infectious conference, USA, ASH meeting in USA, South Asia Diabetes conference in Malaysia
APICON National conferences 10 RSSDI National conference, Critical care national conference, State conferences. Delivered guest lecturers in IMA meetings & API meetings.
Attended International workshop on effective clinical teaching in Groningen, Netherlands

Rahul Sai Gangula

Junior Resident
KMC Manipal, MAHE
Manipal, Karnataka, India

Junior resident in dept of medicine KMC Manipal

Weena Stanley

Associate Professor
Department of Medicine, KMC Manipal, India
Manipal, Karnataka, India

Working as Associate Professor in Internal Medicine. Special interests is diabetes, lipids & endocrine diseases

Dhanjunjay Bhat

Assistant Professor
KMC Manipal, MAHE
Manipal, Karnataka, India

Working as Asst Professor in Internal medicine. Special interest lipids & oncology

Venkatesh Chowdary

Senior Resident, Department of Medicine
KMC Manipal, MAHE
Manipal, India

Working as Senior resident in department of medicine after completing 3 years training in Internal Medicine. Special interests in research include in oncology , gastroenterology and endocrine diseases