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Ascitic Fluid

Serum-Ascites Albumin Gradient

February 15th, 2021


The serum-ascites albumin gradient (SAAG) is used to differentiate between portal hypertension and other causes of ascites.
  • Formula

  • SAAG = [serum albumin] - [ascitic albumin]

Elevated Serum-Ascites Albumin Gradient

Elevated SAAG (>1.1 g/dL) is indicative of portal hypertension.
  • Causes of Ascites with Elevated SAAG

  • Cirrhosis
  • Cardiac ascites
  • Alcoholic hepatitis
  • Massive liver metastasis
  • Fulminant hepatic failure
  • Portal venous thrombosis

Reduced Serum-Ascites Albumin Gradient

Ascites with a low SAAG (<1.1 g/dL) is suggestive of a non-portal hypertension cause of ascites.
  • Causes of Ascites with Reduced SAAG

  • Infection - bacterial peritonitis, pancreatitis, TB
  • Malignancy
  • Nephrotic syndrome
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