Ascites (serum - ascites albumin gradient < 1.1 g/dL)

Serum-ascites albumin gradient is calculated via subtracting the concentration of the ascites fluid albumin from serum albumin (1)

• a serum-ascites albumin gradient of more than or equal to 1.1 g/dL predicts portal hypertension with greater accuracy than the transudate/exudate classification
  • causes of a low serum-ascites albumin gradient (of less than 1.1 g/dL) include: (2)
    • Peritoneal carcinomatosis
    • Pancreatitis
    • Biliary pancreatitis
    • Peritoneal tuberculosis
    • Chlamydia/gonococcal infection
    • Nephrotic syndrome
    • Connective tissue diseases

Reference:

1. Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med. 1992 Aug 01;117(3):215-20
2. Runyon BA., AASLD Practice Guidelines Committee. Management of adult patients with ascites: an update. Hepatology. 2009 Jun;49(6):2087-107.