Document Detail

Diagnostic paracentesis. A two-step approach.
MedLine Citation:
PMID:  8781999     Owner:  NLM     Status:  MEDLINE    
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 10(9)/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 10(9)/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 10(9)/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 10(9)/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.
M Sartori; S Andorno; M Gambaro; F Leone; G L Molinari; L Pontiroli; M Aglietta
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Italian journal of gastroenterology     Volume:  28     ISSN:  0392-0623     ISO Abbreviation:  Ital J Gastroenterol     Publication Date:    1996 Feb-Mar
Date Detail:
Created Date:  1996-11-04     Completed Date:  1996-11-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8000544     Medline TA:  Ital J Gastroenterol     Country:  ITALY    
Other Details:
Languages:  eng     Pagination:  81-5     Citation Subset:  IM    
Dipartimento di Scienze Biomediche ed Oncologia Umana dell'Università di Novara, Italy.
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MeSH Terms
Albumins / analysis
Ascites / diagnosis*,  etiology
Ascitic Fluid / chemistry*,  cytology*
Case-Control Studies
Heart Diseases / complications
Liver Cirrhosis / complications
Liver Neoplasms / complications
Middle Aged
Paracentesis / methods*
Peritoneal Neoplasms / complications
Peritonitis / complications
Predictive Value of Tests
Sensitivity and Specificity
Serum Albumin / analysis
Reg. No./Substance:
0/Albumins; 0/Serum Albumin

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