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Serum-ascites albumin gradient

Calculation used in medicine

Summary

Calculation used in medicine

The serum-ascites albumin gradient or gap (SAAG) is a calculation used in medicine to help determine the cause of ascites. The SAAG may be a better discriminant than the older method of classifying ascites fluid as a transudate versus exudate.

The formula is as follows: :SAAG = (serum albumin) − (albumin level of ascitic fluid).

Ideally, the two values should be measured at the same time.

This phenomenon is the result of Starling's forces between the fluid of the circulatory system and ascitic fluid. Under normal circumstances the SAAG is

Differential

High gradient

A high gradient ( 1.1 g/dL, 11 g/L) indicates the ascites is due to portal hypertension, either liver related or non-liver related, with approximately 97% accuracy. This is due to increased hydrostatic pressure within the blood vessels of the hepatic portal system, which in turn forces water into the peritoneal cavity but leaves proteins such as albumin within the vasculature.

Important causes of high SAAG ascites ( 1.1 g/dL, 11 g/L) include: cirrhosis of the liver, heart failure, Budd–Chiari syndrome, portal vein thrombosis, and idiopathic portal fibrosis.

Low gradient

A low gradient (

SAAG	Total Ascites Protein
	Tuberculous Peritonitis, Nephrotic syndrome
2.5 g/dL	Cancer, Tuberculosis, Chylous ascites, Pancreatitis

References

(March 2008). "Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results?". JAMA.
(August 1992). "The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites". Annals of Internal Medicine.
(15 April 2004). "Management of Cirrhosis and Ascites". New England Journal of Medicine.

Wikipedia Source

This article was imported from Wikipedia and is available under the Creative Commons Attribution-ShareAlike 4.0 License. Content has been adapted to SurfDoc format. Original contributors can be found on the article history page.

medical-tests hepatology

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