Serum-Ascites Albumin Gradient: A predictor of esophageal varices with ascites

• Published in: Indian journal of pediatrics Vol. 68; no. 6; pp. 511 - 514
• Main Authors: DAS, Bibhuti B, PUROHIT, Alok, ACHARYA, Usha, TRESKO, Erena
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01-06-2001
• Subjects: Adolescent; Ascitic Fluid - chemistry; Biological and medical sciences; Child; Child, Preschool; Esophageal and Gastric Varices - diagnosis; Esophageal and Gastric Varices - etiology; Esophagoscopy; Esophagus; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Hypertension, Portal - diagnosis; Hypertension, Portal - etiology; Infant; Liver Cirrhosis - complications; Liver Cirrhosis - diagnosis; Male; Medical sciences; Other diseases. Semiology; Prospective Studies; Risk Factors; Serum Albumin - analysis; Tropical medicine; Asia; India; Human; Glomerulonephritis; Kidney disease; Urinary system disease; Effusion; Predictor; Albumin; Biological marker; Cardiovascular disease; Hepatic disease; Nephrotic syndrome; Venous disease; Esophagus; Vascular disease; Cirrhosis; Abdominal disease; Digestive diseases; Serum; Ascites; Child; Varix
• ISSN: 0019-5456; 0973-7693
• DOI: 10.1007/BF02723242

Other investigators have found that in adults the Serum-Ascites Albumin Gradient (SAAG) to be 1.1 g/dl or greater in the presence of portal hypertension (PTHN) and less than that in its absence. We sought to determine the correlation between the level of SAAG and the complications of PTHN, manifested by the presence of esophageal varices in children with ascites. Our study included 26 patients with cirrhosis, diagnosed by liver biopsy and 14 patients with nephrotic syndrome (NS) diagnosed by established criteria. The SAAG was measured in all patients. The patients with cirrhosis had upper gastrointestinal (GI) endoscopy for assessment of esophageal varices (EV). We found that 84.6% (22 of 26) patients with cirrhosis had High SAAG (> or = 1.1 g/dl) and 15.4% (4 of 26) had low SAAG (< 1.1 g/dl) (p < 0.001). EV was found in 91% (20 of 22) patients with high SAAG and in 50% (2 of 4) patients with low SAAG (p = 0.013). The SAAG differentiated cirrhosis with EV from those without EV (sensitivity = 91%, specificity = 50%, positive predictive value = 91%, negative predictive value = 50% and efficacy = 85%). The high SAAG is a useful means to predict the presence of EV in children with ascites.