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PubMedDate not supplied

Diagnosing ascitic etiology on a biochemical basis.

BACKGROUND/AIMS: The analysis of ascitic fluid has been complicated by several new tests. To simplify its assessment, we evaluated ascitic fluid pH with six other parameters prospectively and simultaneously in blood and ascitic fluid in sixty patients with ascites. METHODOLOGY: Sixty patients were selected on whom abdominal paracentesis was performed in order to determine which tests were the most reliable for the etiological diagnosis of ascites. Their ascitic fluid pH, cholesterol, albumin, and total proteins were analyzed to distinguish between malignant and cirrhotic ascites. The diagnosis of cirrhosis was based on histological findings, and/or clinical, biochemical, and endoscopic/ultrasonographic findings in whom percutaneous liver biopsy was contraindicated. RESULTS: The serum-ascites albumin gradient was higher (p<0.001) in cirrhotic as compared to tubercular, malignant or cardiac ascites. We discovered that ascitic fluid lactate dehydrogenase and cholesterol were best for diagnosing malignant ascites, ascitic fluid glucose and ascitic fluid/blood glucose ratio were perfect for diagnosing tubercular ascites, and ascitic fluid pH and lactate dehydrogenase were suitable for diagnosing spontaneous bacterial peritonitis. Correspondingly, ascitic fluid albumin, ascitic fluid/serum albumin, total proteins, and serum ascites albumin gradient were best for diagnosing sterile cirrhotic ascites. CONCLUSIONS: Diagnostic paracentesis is a useful procedure. The practice of ordering a battery of tests on every ascitic fluid specimen should be abandoned. Rather, an algorithm approach should be adopted in which the results of initial analysis guide us to further relent tests that help in arriving at the etiology of ascites.

Albumins↗
PubMed2002

Ascites as a predictor of ovarian malignancy.

OBJECTIVE: To determine the utility of ascites as a predictor of ovarian malignancy and define its relationship with the histologic type of ovarian tumor (benign, borderline, or malignant) and stage of disease. METHODS: This retrospective cohort study analyzed the clinical and pathological finding of 125 patients from two institutions treated for a pelvic mass. Preoperative data to include: physical examination, imaging studies (USD, CT, or MRI), and operative reports were reviewed for evidence of ascites. This was correlated with final pathologic findings and stage of disease. Collected data were summarized with descriptive statistics. Further statistical analysis was performed using Pearson's chi(2), cross tabulation, and the Median Test. Data were analyzed with SPSS 6.1 for Windows. RESULTS: One-hundred twenty-five patients were evaluable for this study. The ovarian pathologic findings were as follows: 57 benign (45%), 12 borderline (10%), and 56 malignant (45%). Fifty-three patients (42%) had frank ascites at laparotomy. Seventy-two patients (58%) had no ascites. All patients with ascites diagnosed preoperatively (n = 41) on physical examination or imaging studies were confirmed intraoperatively. Absence of ascites was correctly diagnosed preoperatively in 72/84 patients (86%). Of the 57 benign tumors, only 5 patients (9%) had small amounts of peritoneal effusion. Of the 12 borderline tumors, 7 patients (58%) had ascites. Of the 56 malignant tumors, 41 (73%) had ascites. Using presence or absence of ascites on clinical assessment as the predictor variable and benign or malignant (borderline and invasive histopathology) tumors as the outcome variable, the positive predictive value (PPV) of ascites to detect ovarian malignancy was 95% and the negative predictive value (NPV) was 64%. When borderline tumors were excluded, the PPV and NPV of ascites to detect malignant invasive tumors were 95 and 73%, respectively. Furthermore, a progressive relationship between stage of ovarian malignancy and percentage of cases with ascites was identified. Ovarian malignancies in the early stages (I and II) produced ascites only in 17% of the cases. In advanced stages (III and IV), 89% produced ascites. In addition, for stage I and II disease, all patients possessed <0.5 liters of ascites at surgery, whereas the majority of patients (66%) with stage III and IV disease had >0.5 liters. CONCLUSIONS: Our findings indicate the presence of ascites on preoperative physical examination or imaging study is highly predictive of ovarian malignancy in women with a pelvic mass. The absence of ascites may not always predict benign disease since nearly half of borderline tumors and 83% of early stage malignant ovarian tumors do not produce ascites. A progressive relationship between stage of malignancy and incidence as well as volume of ascites was also observed.

Adolescent↗
PubMedDate not supplied

Is the acidity of ascitic fluid a reliable index in making the presumptive diagnosis of spontaneous bacterial peritonitis?

Ascitic fluid pH and arterial-ascitic fluid pH gradient were compared to ascitic fluid polymorphonuclear cell count in 84 patients with cirrhotic ascites and in 12 with malignant ascites to assess their role as diagnostic tests for spontaneous bacterial peritonitis and to clarify the relationship between ascitic fluid pH and lactate. Ascitic fluid pH was significantly lower (pH 7.30) in spontaneous bacterial peritonitis (n = 18) and probable spontaneous bacterial peritonitis (n = 12) than in sterile ascites (pH 7.41; n = 54). Since blood pH levels were not different in the presence of infection, arterial-ascitic fluid pH gradient was significantly higher in spontaneous bacterial peritonitis and probable spontaneous bacterial peritonitis than in sterile ascites (0.12 vs. 0.02). The close correlations between arterial-ascitic pH gradient and lactate (r = 0.77, p less than 0.0001), lactate and bicarbonate gradient (r = 0.64, p = 0.003) and arterial-ascitic pH gradient and pCO2 gradient (r = -0.90, p less than 0.0001) suggest that the low ascitic fluid pH may be due to an increase in lactate and CO2. Patients with Escherichia coli-induced spontaneous bacterial peritonitis had significantly lower ascitic fluid pH and higher lactate than those with spontaneous bacterial peritonitis by other organisms. Values of ascitic fluid pH, lactate and arterial-ascitic fluid pH gradient in malignant ascites were similar to those of spontaneous bacterial peritonitis and probable spontaneous bacterial peritonitis. Cutoff points, selected by receiver operating characteristic curves analysis, of 450 per mm3 for polymorphonuclear cells and of 0.07 for arterial-ascitic fluid pH gradient, allow high positive and negative predictive values for spontaneous bacterial peritonitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

pH of ascitic fluid: diagnostic and prognostic value in cirrhotic and noncirrhotic patients.

The pH measurements of 185 samples of ascitic fluid in 169 cirrhotic and 16 noncirrhotic patients were analyzed to assess their diagnostic and prognostic value. The 169 cirrhotic patients were divided into four groups: sterile ascites (group 1), spontaneous bacterial peritonitis (group 2), probable spontaneous bacterial peritonitis (group 3), and bacterascites (group 4). Mean ascitic fluid pH values were lower (p less than 0.001) in patients of groups 2 (7.24 +/- 0.17) and 3 (7.34 +/- 0.11) than in patients of groups 1 (7.44 +/- 0.06) and 4 (7.45 +/- 0.08), but there was an important overlap between these groups. Mean arterial-ascitic fluid pH gradient values were higher (p less than 0.001) in patients of groups 2 (0.21 +/- 0.16) and 3 (0.10 +/- 0.13) than in patients of groups 1 (0.02 +/- 0.05) and 4 (0.02 +/- 0.05). This gradient had a better discriminant power than ascitic fluid pH alone. Sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy for the diagnosis of certain or probable spontaneous bacterial peritonitis were, respectively, 47%, 99%, 88%, 89%, and 89% for ascitic fluid pH values less than 7.32; 66%, 99%, 91%, 93%, and 92% for arterial-ascitic fluid pH gradient values greater than 0.10; and 97%, 96%, 86%, 99%, and 96% for polymorphonuclear cell count greater than 75/microliter. Ascitic fluid pH values appeared to have a high prognostic value, as 6 of 7 cirrhotic patients with ascitic fluid pH values less than 7.15 died rapidly. Low ascitic fluid pH values were found in patients with malignant and pancreatic ascites and tuberculous peritonitis but not in patients with cardiac ascites. We conclude that in cirrhotic patients with certain or probable spontaneous bacterial peritonitis (a) arterial-ascitic fluid pH gradient measurements had a slightly higher diagnostic value than ascitic fluid pH measurements but a slightly lower diagnostic value than polymorphonuclear cell count and (b) ascitic fluid pH measurements had a high prognostic value. In noncirrhotic patients, ascitic fluid pH and arterial-ascitic fluid pH gradient measurements had a poor diagnostic value.

Adolescent↗