Ascites in the state of Qatas: aetiology and diagnostic value of ascitic fluid analysis

Kahn FY
Correspondence: Dr Fahmi Yousef Khan, fakhanqal@yahoo.co.uk

ABSTRACT
Introduction Ascites is common and represents an important feature of liver disease and other diseases. The aim of this study is to determine the causes of ascites in Qatar, and to evaluate the value of ascitic fluid analysis in different types of ascites.
Methods This is a descriptive, prospective study of all patients admitted to the medical department at Hamad General Hospital with ascites between January 2004 and January 2005.
Results Of the 104 patients enrolled in the study, 70 (67.3 percent) were males and 34 (32.7 percent) were females, with a mean age of 52.9 (+/-14.8) years. Liver cirrhosis was the most frequent cause of ascites in 62 patients (59.6 percent), while chronic alcoholism was the main cause of liver cirrhosis. Other frequent causes of ascites were malignant ascites in 12 patients (11.5 percent), malignancy-related ascites in ten patients (9.6 percent), and tuberculous peritonitis in eight patients (7.7 percent). Based on the serum-ascites albumin gradient (SAAG), different causes of ascites were divided into two main groups. The first group was characterised by a mean SAAG of 1.1 or higher, and the second group was characterised by a mean SAAG of less than 1.1. The most common cause of high gradient ascites was liver cirrhosis, while the most common causes of low gradient ascites were carcinomatous peritonitis and tuberculous peritonitis. The mean ascitic lactate dehydrogenase (LDH) level was higher in cancer patients than in tuberculous patients (p-value is less than 0.05), while the mean ascitic glucose concentration was significantly lower in peritoneal tuberculosis than in carcinomatous peritonitis (p-value is less than 0.05).
Conclusion Liver cirrhosis is the main cause of ascites in Qatar. SAAG is a better distinguishing marker for separating ascites related to portal hypertension from other causes of ascites without portal hypertension. In patients with low gradient ascites, ascitic fluid glucose and LDH level are useful indicators for separating tuberculous from malignant ascites.

Keywords: ascites, carcinomatous peritonitis, paracentesis, serum-ascites albumin gradient, tuberculosis
Singapore Med J 2007; 48(5): 434–439