SERUM ASCITES ALBUMIN GRADIENTS IN NONALCOHOLIC LIVER-DISEASE

Several studies performed in alcoholics with advanced liver disease have demonstrated a positive correlation between the serum-ascites albumin gradient (SAAG) and measured portal venous pressure. A single study performed in 15 patients with exudative malignant ascites and 29 patients with alcoholic liver disease demonstrated that a SAAG of <1.1 was essentially diagnostic of a malignant origin of the ascites. In an effort to confirm and extend these observations to individuals with nonalcoholic liver disease, 24 patients with nonalcoholic liver disease and 11 with alcoholic liver disease undergoing orthotopic liver transplantation (OTLx) were studied. At the time of liver transplantation, each had their serum and ascitic fluid albumin levels determined, the gradient calculated, and their portal venous pressure (PVP) as well as the corrected portal venous pressure (PPc) measured directly. A significant correlation (r=0.624) between the PPc and the SAAG was found in the 11 alcoholics (P<0.05). No such correlation existed for those with nonalcoholic liver disease (r=0.398). Moreover, a SAAG <1.1 was found in three of nonalcoholics with cirrhosis in the absence of an abdominal malignancy. We conclude that (1) the SAAG and PPc are statistically related to each other in individuals with alcoholic liver disease but not in those with a nonalcoholic cause for cirrhosis, and (2) SAAG <1.1 is not diagnostic of abdominal malignancy but can occur in those with advanced nonmalignant hepatic disease. © 1990 Plenum Publishing Corporation.