Biochemical, cytological and microbiological characteristics of the cirrhotic, malignant and 'mixed' ascites

BACKGROUND: The aim of this study is to determine the value of some biochemical, cytological and microbiological analysis of ascitic fluid and serum that, used alone or in combination, can help in differential diagnosis of ascites. METHODS: Ninety patients with ascites, hospitalized during the period between 1995 and 1998, were prospectively studied. In 56 patients liver cirrhosis, 27 patients malignant tumors, and in 7 patients liver cirrhosis plus hepatocellular carcinoma were the causes of ascites. RESULTS: The average glucose, total protein and cholesterol concentration of the ascitic fluid and serum of patients with liver cirrhosis, malignant tumors and liver cirrhosis plus hepatocellular carcinoma were retrospectively: glucose [(6.24; 6.08), (5.25; 5.99), (7.65;6.16) mmol/l], total protein [(16.71; 59.89), (36.12; 60.69), (17.08; 66.57 g/l], cholesterol [(1.16; 4.87), (2.85; 5.27), (1.41; 5.54 mmol/l], and ascitic fluid/serum ratio [(1.02; 0.27; 0.23), (0.87; 0.59; 0.54), (1.24; 0.25; 0.25)]. The mean value of serum ascites albumin gradient in these three groups of patients was respectively: [22.57, 10.97, 23.21 g/l]. The concentration of the total proteins and cholesterol were significantly higher in malignant than in cirrhotic ascitic fluid, (p<0.001). In the group of patients with malignant ascitic fluid, in 33,33% of patients we found malignant cells in ascites. Spontaneous bacterial peritonitis was detected only in a group with liver cirrhosis in case of 10 patients (17.86%) with single type of organism in all. CONCLUSION: Our study confirmed that biochemical, cytological and microbiological examinations are very helpful in differential diagnosis of ascites.