血清腹水白蛋白梯度在墨西哥门静脉高压相关腹水患者中的诊断效用

Diagnostic utility of the serum-ascites albumin gradient in Mexican patients with ascites related to portal hypertension.

作者信息

Cervantes Pérez Enrique, Cervantes Guevara Gabino, Cervantes Pérez Gabino, Cervantes Cardona Guillermo Alonso, Fuentes Orozco Clotilde, Pintor Belmontes Kevin Josué, Guzmán Ramírez Bertha Georgina, Reyes Aguirre Laura Lizeth, Barbosa Camacho Francisco José, Bernal Hernández Aldo, González Ojeda Alejandro

机构信息

Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Universidad Nacional Autónoma de México Mexico City Mexico.

Department of Welfare and Sustainable Development University Center of the North, University of Guadalajara Colotlan Mexico.

出版信息

JGH Open. 2020 Aug 8;4(5):838-842. doi: 10.1002/jgh3.12404. eCollection 2020 Oct.

DOI:10.1002/jgh3.12404

PMID:33102752

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7578298/

Abstract

BACKGROUND AND AIM

Analysis of ascitic fluid is necessary to determine the etiology and to distinguish portal hypertension (PH)-related and unrelated ascites. Numerous diagnostic parameters have been studied, but no single parameter has completely distinguished these. We aimed to validate the serum albumin-ascites gradient (SAAG) for the diagnosis of ascites secondary to PH and to establish cutoff points to predict PH using its sensitivity and specificity.

METHODS

This was a cross-sectional study conducted on patients diagnosed with ascites of any etiology. The SAAG and albumin concentration in ascitic fluid (AFA) were measured to establish their sensitivity and specificity for determining the presence or absence of PH. Cutoff points and levels of statistical significance were established based on the area under the curve.

RESULTS

Eighty-seven patients were evaluated, of whom 74 (84%) were men, with an average age of 54.0 ± 13.6 years. Seventy-two (83%) were diagnosed at admission with PH-related ascites and 15 (17%) with non-PH-related ascites. SAAG correctly classified 48 (67%) patients, but 24 (33%) were classified incorrectly, while AFA classified 59 (82%) correctly and only 13 (17%) incorrectly. The diagnostic accuracy of SAAG was 57 73% for AFA. AFA had a sensitivity of 82% and specificity of 66% (95% confidence interval [CI]: 0.63-0.93), while SAAG had a sensitivity of 66% but a specificity of 86% (95% CI: 0.72-0.95).

CONCLUSIONS

The SAAG showed poor diagnostic performance with low sensitivity but high specificity. The diagnostic accuracy of AFA is superior to that of SAAG in discriminating between PH and non-PH ascites.

摘要

背景与目的

分析腹水对于确定病因以及区分门静脉高压（PH）相关和不相关腹水很有必要。已经研究了众多诊断参数，但没有单一参数能完全区分这些情况。我们旨在验证血清白蛋白-腹水梯度（SAAG）用于诊断PH继发性腹水，并利用其敏感性和特异性确定预测PH的截断点。

方法

这是一项针对诊断为任何病因腹水患者的横断面研究。测量SAAG和腹水白蛋白浓度（AFA），以确定它们在判断是否存在PH方面的敏感性和特异性。基于曲线下面积确定截断点和统计学显著性水平。

结果

共评估了87例患者，其中74例（84%）为男性，平均年龄54.0±13.6岁。72例（83%）在入院时被诊断为PH相关腹水，15例（17%）为非PH相关腹水。SAAG正确分类了48例（67%）患者，但24例（33%）分类错误，而AFA正确分类了59例（82%），仅13例（17%）错误分类。SAAG的诊断准确率为57%，AFA为73%。AFA的敏感性为82%，特异性为66%（95%置信区间[CI]：0.63 - 0.93），而SAAG的敏感性为66%，特异性为86%（95%CI：0.72 - 0.95）。