Serum ascites albumin gradient (SAAG)

Ascites, defined as a pathological accumulation of fluid in peritoneal cavity, may accompany several diseases. Chronic liver disease, especially cirrhosis, is related with ascites.

The serum ascites albumin gradient (SAAG), which is based on the difference between the albumin level of serum and of ascitic fluid, may be used to assess the extent of ascites (1,2,3)

The SAAG is thought to reflect the colloid osmotic pressure gradient and the degree of portal hypertension

• been shown that SAAG is a better discriminator of portal hypertension than ascites (1)

According to this parameter, a high SAAG is regarded as a gradient greater than 1.1 g/dL. This condition has some differential diagnoses such as liver cirrhosis, Budd-Chiari syndrome, heart failure, and idiopathic portal fibrosis

• the obstruction of hepatic venous outflow causes Budd-Chiari syndrome
  • obstruction is the result of mass or thrombi in the large hepatic veins and venae cavae

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References:

1. Al-Knawy B. Aetiology of ascites and diagnostic value of serum ascites albumin gradient in non-alcoholic liver disease. Ann Saudi Med 1997 Jan;17(1):26-28.
2. Das BB, Purohit A, Acharya U, Treskova E. Serum-ascites albumin gradient: a predictor of oesophageal varices with ascites. Indian J Pediatr 2001 Jun;68(6):511-514.
3. Runyon BA, Practice Guidelines Committee, American Association for the Study of Liver Diseases (AASLD). Management of adult patients with ascites due to cirrhosis. Hepatology 2004;39:841-56. doi:10.1002/hep.20066.