Background: Ascite is one of the most important symptoms of underlying diseases that a complete evaluation of it makes the suitable treatment possible. Because of neumerous procedures in diagnosis of ascitic fluid and inauthenticity of the information in this regard, this study was performed to evaluate the nature of ascitic fluid with two ascite-serum albumin gradient and transudate-exudate methods on hospitalized ascitic patients admitted to Shaheed Beheshti Hospital during the 1994-2003.

Materials and Methods: Descriptive study with diagnostic value was performed on ascitic patients hospitalized in all age ranges. Firstly, all patients with absolute ascite, diagnosed through CT scan, sonography and parasynthesis were evaluated and then necessary demographic data and the ascitic causes i.e. cirrhosis, heart failure, nephrotic syndrome, multiple ascite with various reasons or pancreas diseases were recorded. After taking consent, Patients were parasynthesied. Ascite liquid (50-100CC) and arm citrated blood (5CC) were taken and sent to laboratory. Total protein of ascite fluid, serum and ascitic liquid albumin were determined cytologic study, staing and acid fast and culturing were also done. After taking answers, was each case with ascite liquid protein of ≥2.5 mg/dI and the ones with the protein of <2.5 mg/dI was classified in exudates and transudate group respectively. To determine the gradient, albumin of ascite liquid subtracted from serum albumin. The patients with the result of ≥ 1.1 were put in high gradient group and those with the result of < 1.1 were classified in low gradient one. Also, sensitivity and characteristic , means, standard deviation of the two methods along with the were obtained. By sensitivity .

Results: 100 patients with ascitic were studied, 56 of whom were male with average age of (X ± SD) 55.2 ± 16.4 and the rest were female with average age of (X ± SD) 54.9 ± 15.4 61% of the patients were more than 60. The most common reason of ascite (65%) was cirrhosis. Heart failure (14%) and malignancies (11%) were classified in 2nd and 3rd ranks. The sensitivity of transude-exuda and gradient albumin 47% and 73% respectively and the characteristic of transude-exuda method to gradient albumin was 80.3%. Also agreement coeficiency was 44% (K=0.44). The highest rate of conformity and transude-exude and gradient albumin method in recognizing infectious peritonite and multiple ascite were variable reasons (100%) and hepatitic cirrhosis (89.2%). The least rate of agreement was conjestive heart failure (21.4%).

Conclusion: The most common cause of ascite was hepatitic cirrhosis and the most agreement of two transudate-exudate and albumin gradient method, was infectious peritonitis and Mixed ascite, mean while, sensitivity and specifity of albumin gradient and specifity of transudate-exudate to albumin gradient had the highest agreement.