Cytological and biochemical correlation of ascitic fluid with clinical features in a tertiary care center

• Author Details:   
• Ankitaben Vasantkumar Pandya
• Aishani Tiwari ^*
• Madhur Modi
• Vipul Prajapati
• Krisha Dineshbhai Patel
• Urja Desai

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Background: Ascites involves fluid accumulation in the abdominal cavity due to various underlying pathological conditions. Effective evaluation of ascitic fluid and it’s possible etiology is crucial for accurate diagnosis and management, reducing uncertainties healthcare providers might face.
Materials and Methods: This study included 120 patients of both sexes with ascites. Ascitic fluid was collected and its physical properties determined. Microscopic examinations (Smears and cell blocks) were performed to identify cell types in the fluid. The findings were correlated with biochemical and clinical features to confirm the diagnosis.
Results: Among the patients studied, cases were assessed as non-diagnostic, negative for malignancy, atypical, suspicious for malignancy and positive for malignancy. Malignancy was detected in approximately 14.2% of cases.  81.6% cases were detected as negative for malignancy category with male predominance. The majority of cases (68%) were attributed to cirrhosis and congestive cardiac failure (CCF). A significant 74% of patients displayed a high serum-ascites albumin gradient (SAAG), indicating portal hypertension typically associated with liver cirrhosis and CCF. A strong correlation was found between high ascitic fluid total protein (AFTP) levels (?2.5 g/dL) and conditions such as CCF and peritoneal carcinomatosis. Transudative ascites was present in 72% of patients & 28% demonstrated exudative ascites.
Conclusion: Analysis of ascitic fluid is essential for identifying the underlying causes of ascites. Important diagnostic parameters include SAAG & total protein levels. SAAG is critical for differentiating ascitic causes related to portal hypertension from other etiologies, providing better diagnostic accuracy than total protein alone. 

Keywords: Ascitic fluid, Biochemical analysis, Clinical correlation