Interest of Serum-Ascites Albumin Concentration Gradient in the Diagnosis of Portal Hypertension in Cirrhotic Patients

Abstract

Objective: To find a more accessible and less restrictive mean such as serum-ascites albumin gradient (SAAG) to predict esophageal varices (EV) in cirrhotics with ascit. Patients and methods: Descriptive and analytical studies based on the retrospective collection of data on 125 patients’ records in the hepatogastroenterology unit of the University Hospital Campus of Lome (Togo) from January 1, 2008 to March 31, 2018 were included. Cirrhotic patients aged 15 years and older had performed cytochemical analysis of ascites fluid and upper gastrointestinal fibroscopy and had a protidogram. Statistical analysis was done by R Studio Software 3.4.2. Results: The mean age was 48.70 years; there was a male predominance (70.40%) with a sex ratio of 2.38. Protein levels in ascitic fluid was <30 g/l in 88.80% of patients. EV were found in 64.80% of cases. The median SAAG was 1.40 g/dl. EV were significantly more frequent in case of high SAAG ≥ 1.10 g/dl, p = 0.0208. There was no correlation among SAAG and the grade of EV, red signs, gastric varices and portal hypertension gastropathy. Patients with SAAG ≥ 1.10 g/l had 1.63 times the risk of having EV (95% CI 0.63 - 4.15, p = 0.3020). At the threshold of 0.91 g/dl, the sensitivity was 83.95% and the specificity 40.90%; the area under the ROC curve was 0.61. Conclusion: Our study noted that at an upper threshold of 1.10 g/dl, the SAAG significantly predicted the presence of EV.