Diagnostic Sensitivity and Specificity of Serum Ascites Albumin Gradient
(SAAG) in Patients with Ascites
Muhammad Sajid Abbas Jaffri, Altaf Ahmed Shaikh, Mukhtiar Hussain Jaffri, Aslam Khushk,Mashoor Alam Shah, S.M Munir.
OBJECTIVE: To determine the sensitivity and specificity of SAAG in predicting the presence of
esophageal varices and to find out the association between level of SAAG and increase in portal
STUDY DESIGN: Prospective-observational study.
PLACE AND DURATION OF STUDY: Medical Unit III, JPMC Karachi from August 1999 to March
PATIENTS AND METHODS: Patients with ascites were selected on the basis of selection criteria
demonstrated by history, physical examination and ultrasonography. Ascitic fluid aspirated for
DR and albumin, and simultaneously blood sample taken for total protein and albumin estimation
at the time of paracentasis. After determining the level of SAAG upper GI endoscopy was
performed. To determine the cause of ascites detailed history was taken and relevant investigations
were carried out. At the end of our study sensitivity and specificity of serum ascites albumin
gradient were determined in comparison of endoscopy findings.
RESULTS: Among 50 subjects SAAG more than 1.1-g/dl was found in 30 (60%) patients and less
than 1.1-g/dl in 20 patients (40%) of total 50 patients. Out of 30 patients with gradient more than
1.1-g/dl oesophageal varices present in 27 patients and portal vein diameter more than 1.3-cm
present in 24 patients. The commonest cause of ascites among subjects with SAAG more than
1.1-g/dl was chronic liver disease with portal hypertension and the commonest cause of ascites
among SAAG less than 1.1-g/dl was abdominal tuberculosis. The sensitivity and specificity of
SAAG were 100% and 87.8% respectively.
CONCLUSION: Serum ascites albumin gradient is a reliable marker to differentiate ascites into
portal hypertensive and non-portal hypertensive etiology. Based upon our finding we conclude
that the presence of oesophageal varices is significantly associated with high SAAG levels.
Key words: Sensitivity, Specificity, Upper GI Endoscopy, SAAG, Ascites.