TY - JOUR
T1 - Diagnostic paracentesis. A two-step approach
AU - Sartori, M.
AU - Andorno, S.
AU - Gambaro, M.
AU - Leone, F.
AU - Molinari, G. L.
AU - Pontiroli, L.
AU - Aglietta, M.
PY - 1996
Y1 - 1996
N2 - Diagnostic paracentesis is usually considered the first test to be performed in the assessment of the ascitic patient and a large number of investigations on ascitic fluid have been proposed. To assess the value of a simplified procedure, serum to ascites albumin gradient and ascitic white blood cell counts were employed as a first step. One hundred and fifty-three paired serum and ascitic fluid samples were analysed and allowed patients to be divided into three groups: 1) serum to ascites albumin gradient > = 11 g/L and white blood cells <0.5 x 109/L predicted cirrhosis (or liver carcinoma) without peritonitis, with 83% efficacy, 96% positive predictive value and 65% negative predictive value; 2) serum to ascites albumin gradient > = 11 g/L and white blood cells > = 0.5 x 109/L predicted cirrhosis (or liver carcinoma) with peritonitis with 86% efficacy, 45% positive predictive value and 99% negative predictive value; 3) serum to ascites albumin gradient <11 g/L predicted, the other diagnoses with 92% efficacy, 77% positive predictive value and 95% negative predictive value. As serum to ascites albumin gradient > = 11 g/L and white blood cells <0.5 x 109/L predicted cirrhosis (or liver carcinoma) without peritonitis in 96% of the cases and excluded peritonitis in 99% of the cases, further fluid ascitic analyses could be considered as a second step only in patients with serum to ascites albumin gradient <11 g/L and/or white blood cells > = 0.5 x 109/L. In a group of ascitic patients where the prevailing diagnosis is cirrhosis (or liver carcinoma) without peritonitis, this simplified approach could provide a favourable cost/benefit ratio.
AB - Diagnostic paracentesis is usually considered the first test to be performed in the assessment of the ascitic patient and a large number of investigations on ascitic fluid have been proposed. To assess the value of a simplified procedure, serum to ascites albumin gradient and ascitic white blood cell counts were employed as a first step. One hundred and fifty-three paired serum and ascitic fluid samples were analysed and allowed patients to be divided into three groups: 1) serum to ascites albumin gradient > = 11 g/L and white blood cells <0.5 x 109/L predicted cirrhosis (or liver carcinoma) without peritonitis, with 83% efficacy, 96% positive predictive value and 65% negative predictive value; 2) serum to ascites albumin gradient > = 11 g/L and white blood cells > = 0.5 x 109/L predicted cirrhosis (or liver carcinoma) with peritonitis with 86% efficacy, 45% positive predictive value and 99% negative predictive value; 3) serum to ascites albumin gradient <11 g/L predicted, the other diagnoses with 92% efficacy, 77% positive predictive value and 95% negative predictive value. As serum to ascites albumin gradient > = 11 g/L and white blood cells <0.5 x 109/L predicted cirrhosis (or liver carcinoma) without peritonitis in 96% of the cases and excluded peritonitis in 99% of the cases, further fluid ascitic analyses could be considered as a second step only in patients with serum to ascites albumin gradient <11 g/L and/or white blood cells > = 0.5 x 109/L. In a group of ascitic patients where the prevailing diagnosis is cirrhosis (or liver carcinoma) without peritonitis, this simplified approach could provide a favourable cost/benefit ratio.
KW - Ascites
KW - Ascitic fluid analysis
KW - Cirrhosis
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M3 - Article
C2 - 8781999
AN - SCOPUS:0029984108
VL - 28
SP - 81
EP - 85
JO - Italian Journal of Gastroenterology
JF - Italian Journal of Gastroenterology
SN - 0392-0623
IS - 2
ER -