Diagnostic efficacy of serum ascitic cholesterol gradient and ascitic cholesterol in differentiating benign and malignant ascites - a cross sectional study

Abstract

Background: Ascites, the abnormal accumulation of fluid in the peritoneal cavity, can arise from various benign and malignant conditions. The differential diagnosis of ascites is crucial for determining appropriate treatment. This study investigates the diagnostic efficacy of the serum ascitic cholesterol gradient (SACG) and ascitic cholesterol levels in distinguishing between benign and malignant ascites.Methods: This cross-sectional observational study included 75 patients with ascites at Saveetha Medical College Hospital. Participants were categorized into benign and malignant ascites groups based on clinical, biochemical, and radiographic findings. Serum and ascitic fluid samples were analyzed for albumin and cholesterol levels. The diagnostic efficacy of SACG was compared to serum ascitic albumin gradient (SAAG) and cytology for malignant cells.Results: The study found significant differences in serum and ascitic fluid cholesterol levels between benign and malignant ascites groups. SACG demonstrated higher sensitivity (94.4%) and specificity (96.49%) compared to SAAG (sensitivity 88.8%, specificity 91.2%) in differentiating malignant from benign ascites. SACG also showed superior diagnostic accuracy.Conclusion: SACG is a valuable diagnostic tool for distinguishing between benign and malignant ascites, offering higher accuracy compared to traditional markers such as SAAG. Incorporating SACG into routine diagnostic protocols may improve early diagnosis and treatment of malignant ascites