Ascitic lipids and albumin gradient in the differentiation between cirrhotic and malignant ascites in Nigerian Africans

The purpose of this study was to investigate the efficacy of ascitic fluid lipid analysis, and to compare it with albumin gradient and AF total protein in discriminating between cirrhotic ascites and ascites caused by malignancies in Nigerian patients. 40 consecutive ascitic patients, (22 with cirrhotic ascites and 18 with neoplasms metastatic to the peritoneum) were studies prospectively. The roup with liver cirrhosis (LC) consisted of non-alcoholics; 60 percent were hepatitis B surface antigen positive. The patients with malignant ascites comprised four with ovarian carcinoma; three each of lymphoma, gastric and breast carcinoma; two bronchogenic carcinoma; and one each of prostatic, testicular and colon carcinoma. The results show that AF cholesterol provides excellent discrimination between the two types of ascites. Of five diagnostic parameters tested, AF cholesterol gave the best combination of results for the predictive value of a positive test and the predictive value of a negative test. Determination of AF cholesterol and albumin gradient are useful in differentiation ascites caused by malignancies from ascites due to LC. However, AF cholesterol measurement may have considerable advantages in cost effectiveness