TO STUDY THE USEFULNESS OF SERUM AND ASCITIC FLUID C-REACTIVE PROTEIN (CRP) AND ASCITIC FLUID CHOLESTEROL LEVEL IN DIFFERENTIAL DIAGNOSIS OF MALIGNANT, NONMALIGNANT AND TUBERCULAR ASCITES

BACKGROUNDAscites is a common clinical problem.However, the capability to distinguish malignant from non-malignant and tubercular causes of ascites using available biochemical techniques would obviate many expensive and time-consuming diagnostic studies on patients presenting with ascites of unknown aetiology.Therefore, this study was planned to evaluate usefulness of serum & ascitic fluid C-Reactive Protein (CRP), SAAG and ascitic fluid cholesterol level in diagnosis of malignant, non-malignant and tubercular ascites. MATERIALS AND METHODSWe conducted a prospective observational study in 80 patients, those admitted and willing to give consent in the department of Medicine, LLR & Associated Hospitals, GSVM Medical College, Kanpur from December 2015 to October 2017.All patients underwent full investigations to make the diagnosis of ascites malignant (20) and nonmalignant (n=54)), tubercular (7) and nontubercular (47) groups.6 patients were excluded because the ascitic fluid analysis was suggestive of bacterial peritonitis.The data was processed in MS Excel and analysis was carried out using SPSS Ver.23. RESULTSWe found that in the non-malignant group mean value of ascitic fluid CRP was 0.29+0.12vs 3.16+1.42(mg/l) in malignant group, SAAG was 1.81+0.70vs 0.87+0.34(mg/l) in non-malignant vs malignant group.The mean value of ascitic fluid cholesterol in malignant group was 100.85 + 34.28 vs 6.7 + 2.5 in non-malignant group (p value <0.01) and the mean value of ascitic fluid cholesterol in malignant group was 100.80 + 34.28 vs 32.43 + 15.7 in tubercular group, so ascitic fluid cholesterol is highly specific (100%) and sensitive (65%) at cut off value of 100 mg/dl in differentiating benign and malignant causes of ascites. CONCLUSIONSAAG, Ascitic fluid CRP, and cholesterol having high specificity, can be used for differentiating between non-malignant and malignant ascites.It can also be used to differentiate tubercular ascites from malignant ascites.