Identifying high and low serum-ascites albumin gradient in ascitic fluid by the point of care dipstick test

Asadabadi, Leyli; Heiran, Mohmmad Mehdy; Mirafzal, Amirhosein

doi:10.15171/jept.2015.03

Identifying high and low serum-ascites albumin gradient in ascitic fluid by the point of care dipstick test

Document Type : Original Article

Authors

Leyli Asadabadi

Mohmmad Mehdy Heiran

Amirhosein Mirafzal

Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran

https://doi.org/10.15171/jept.2015.03

Abstract

Objective: To evaluate the capability of ascitic fluid dipstick results for pH, glucose, and protein in order to predict a low serum-ascites albumin gradient (SAAG) at the bedside of the patient in the emergency department (ED).
Methods: This prospective cross-sectional study was conducted during one year in the ED of Afzalipour hospital in Kerman, Iran. All patients with diagnostic or therapeutic paracentesis of ascitic fluid were considered as eligible patients. Exclusion criteria included clinical suspicion for spontaneous bacterial peritonitis (SBP), any contraindications to paracentesis, and patients’ refusal to participate in the study. Dipstick values were obtained at the bedside, and SAAG was calculated after the determination of serum and ascitic fluid albumin by laboratory. A low SAAG ascitic fluid was defined as the study outcome. We also used our study population as a test group to evaluate an equation proposed in one previous study: K = 0.012 Protein−0.012 Glucose−3.329 pH+23.498
Results: A total of 50 patients were enrolled in the study. Based on multivariate regression analysis, dipstick values for protein and glucose were independently predictive of a low SAAG ascitic fluid (P = 0.23, OR = 1.04; and P = 0.001, OR = 0.81, respectively). The formula proposed in one of the previous studies was tested by our data set, with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at 84%, 83%, 84%, and 80%, respectively.
Conclusion: Dipstick test of ascitic fluid for pH, glucose, and protein has an acceptable sensitivity and specificity as a point of care test, but it cannot be recommended as a substitute for SAAG determination based on the current findings.

Keywords

Serum-asictes albumin gradient

Ascitic fluid

Dipstick test

Subjects

1. Tarn AC, Lapworth R. Biochemical analysis of ascitic (peritoneal) fluid: what should we measure? Ann Clin Biochem 2010; 47(5): 397-407. doi: 10.1258/acb.2010.010048.

2. Mauer K, Manzione NC. Usefulness of serum-ascites albumin difference in separating transudative from exudative ascitic fluid. Dig Dis Sci 1988; 33(10):1208-12. doi:10.1258/acb.2010.010048.

3. Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHuchinson JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differemtial diagnosis of

ascites. Ann Intern Med 1992; 117(3): 215-20. doi: 10.7326/0003-4819-117-3-215.

4. Akriviadis EA, Kapnias D, Hadjigavriel M, Mitsiou A, Goulis J. Serum/ascites albumin gradient: its value as a rational approach to the differential diagnosis of ascites. Scand J Gatroenterol 1996; 31(8): 814-7. doi: 10.3109/00365529609010358.

5. Mansour-Ghanaei F, Shafaghi A, Bagherzadeh AH, Fallah MS. Low gradient ascites: a seven year course review. World J Gastroentrol 2005; 11(15): 2337-9. doi: 10.3748/wjg.v11.i15.2337.

6. Khan J, Pikkarainen P, Karvonen AL, Makela T, Peraaho M, Pehkonen E, et al. Asites: aetiology, mortality, and the prevalence of spontaneous bacterial peritonitis. Scand J Gastroenterol 2009; 44(8): 970-4. doi: 10.1080/00365520902964739.

7. Khandwalla HE, Fasakin Y, El-Searg HB. The utility of evaluating low serum albumin gradient ascites in patients with cirrhosis. Am J Gastroenterol 2009; 104(6): 1401-5. doi: 10.1038/ajg.2009.117.

8. Parsi MA, Atreja A, Zein NN. Spontaneous bacterial peritonitis: recent data onincidence and treatment. Clev Clin J Med 2004; 71(7): 569-76. doi: 10.3949/ccjm.71.7.569.

9. Rerknimitr R, Rungsangmanoon W, Kongkam P, Kullavanijaya P. Efficacy of leukocyte esterase dipstick test as a rapid test in diagnosis of spontaneous bacterial peritonitis. World J Gastroenterol 2006; 12(44): 7183-92.

10. Castellote J, López C, Gornals J, Tremosa G, Fariña ER, Baliellas C, et al. Rapid diagnosis of spontaneous bacterial peritonitis by use of reagent strips. Hepatology 2003; 37(4): 893-9. doi: 10.1016/s0168-8278(02)80151-9.

11. Sapey T, Mena E, Fort E, Laurin C, Kabissa D, Runyon BA, et al. Rapid diagnosis of spontaneous bacterial peritonitis with leukocyte esterase reagent strips in a European and in an American center. J Gastroenterol Hepatol 2005; 20(2): 187-92. doi: 10.1111/j.1440-

1746.2004.03554.x.

12. Butani RC, Shaffer RT, Szyjkowsky RD, Weeks BE, Speights LG, Kadakia SC. Rapid diagnosis of infected ascitic fluid using leukocyte esterase dipstick testing. Am J Gastroenterol 2004; 99(3): 532-7. doi: 10.1111/j.1572-0241.2004.04084.x.

13. Bafandeh Y, Khodaei M. Evaluation of leukocyte esterase reagent strip test to detect spontaneous bacterial peritonitis in cirrhotic patients. Gastroentrol Insights 2012; 4(1): e13. doi: 10.4081/gi.2012.e13.

14. Nousbaum JB, Cadranel JF, Nahon P, Khac EN, Moreau R, Thèvenot T, et al.Diagnostic accuracy of the Multistix 8 SG reagent strip in diagnosis of spontaneous bacterial peritonitis. Hepatology 2007; 45(5): 1275-81. doi: 10.1002/hep.21588.

15. Campillo B, Richardet JP, Dupeyron C. Diagnostic value of two reagent strips (Multistix 8 SG and Combur 2 LN) in cirrhotic patients with spontaneous bacterial peritonitis and symptomatic bacterascites. Gastroenterol Clin Biol 2006; 30(3): 446-52. doi:

10.1016/s0399-8320(06)73201-8

16. Heidari K, Amiri M, Kariman H, Bassiri M, Alimohammadi H, Hatamabadi HR. Differentiation of exudate from transudate ascites based on dipstick values of protein, glucose, and pH. Am J Emerg Med 2013; 31(5): 779-82. doi: 10.1016/j.ajem.2013.01.010