RESUMEN
Se realiza un trabajo prospectivo, en 60 pacientes hospitalizados, portadores de ascitis de diferentes etiologías, analizando la validez de los parámetros dependientes del dosaje de proteínas y albúmina tanto en suero como líquido ascítico, en la discriminación de las posibles causas etiológicas de las ascitis, incluyendo dentro de estos parámetros la concentración de proteínas en el líquido ascítico; la gradiente de albúmina suero-ascitis; el índice proteico ascitis / suero y la concentración de albúmina en el líquido ascítico. RESULTADOS: La edad promedio fue de 46.9 +- 19.6 años, todos del sexo femenino, relacionadas 21 casos con Enfermedad Hepática Crónica, 14 con Tuberculosis, 11 con Neoplasia Maligna, 7 con causa Nefrótica, 4 con Insuficiencia Cardiaca Congestiva, 2 con Enfermedad del Colágeno y 1 con un cuadro de Desnutrición Severa. Los parámetros evaluados, correlacionan con las presiones oncóticas e hidrostáticas de la Ley de Starling, en base a lo que pudieron ser comparados, demostrando que sus niveles de sensibilidad, especificidad, como valores predictivos positivos y negativos se pueden utilizar en las evaluaciones discriminativas de las ascitis en relación a sus causas etiológicas probables. Si bien la gradiente de albúmina suero-ascitis, puede ser útil en la separación de cuadros de ascitis con hipertensión portal, también es útil en catalogar exudados y trasudados, pero no deben ser excluidos los otros parámetros para la evaluación de dichos cuadros, orientando a establecer si existe o no compromiso peritoneal y por sensibilidad y especifidad de estas pruebas que no las diferencian estadísticamente de la gradiente de albúmina suero-ascitis. Utilizando los puntos de corte clásicos para cada parámetro, la de albúmina en 1.5 g/dl y de las proteínas en 2.5 g/dl, podrían ser más adecuados para nuestra población teniendo además el beneficio de un costo menor.
Prospective evaluation was performed in 60 in-patients, carriers of ascites of different etiologies, analyzing the validity of the parameters depending on protein and albumin dosage, both in the ascitic serum and fluid, for the discrimination of possible etiological causes of ascites, including in these parameters Protein Concentration in the Ascitic Fluid, the Serum-Ascites Albumin Gradient, the Protein Ascites/Serum Ratio, and the Albumin Concentration in the ascitic fluid. Average age was 46.9 ± 19.6, all female; 21 cases were associated with Chronic Hepatic Disease, 14 to Tuberculosis, 11 to Malignant Neoplasia, 7 to Nephrotic syndrome, 4 to Congestive Heart Failure, 2 to Collagen Disease, and 1 to a severe Malnutrition case. The evaluation parameters correlate with the oncotic and hydrostatic pressures of the Starling Law, on the basis of what they could be compared with, demonstrating that their sensitivity levels and their specificity may be used as positive or negative predictive values in the discriminative evaluations of ascites in relation to its probable etiological causes. Even though the Serum-Ascites Albumin Gradient may be useful in the separation of ascites cases with portal hypertension, it is also useful for classifying exudates and transudates. However, the other parameters must not be excluded for the evaluation of those cases, aiming at establishing whether the peritoneum has been affected and hence the terms transudates and exudates should still be used on the basis of the high sensitivity value and specificity of theses tests, which do not differentiate them statistically from the Serum-Ascites Albumin Gradient. Using the cut-off points for each parameter, the most adequate for our population would be 1.5 gr/dl for Albumin and 2.5 gr/dl for protein, with the additional lower cost benefit.
Asunto(s)
Humanos , Adolescente , Adulto , Persona de Mediana Edad , Femenino , Ascitis , Exudados y Transudados , Hipertensión PortalRESUMEN
Prospective evaluation was performed in 60 in-patients, carriers of ascites of different etiologies, analyzing the validity of the parameters depending on protein and albumin dosage, both in the ascitic serum and fluid, for the discrimination of possible etiological causes of ascites, including in these parameters Protein Concentration in the Ascitic Fluid, the Serum-Ascites Albumin Gradient, the Protein Ascites/Serum Ratio, and the Albumin Concentration in the ascitic fluid. Average age was 46.9 +/- 19.6, all female; 21 cases were associated with Chronic Hepatic Disease, 14 to Tuberculosis, 11 to Malignant Neoplasia, 7 to Nephrotic syndrome, 4 to Congestive Heart Failure, 2 to Collagen Disease, and 1 to a severe Malnutrition case. The evaluation parameters correlate with the oncotic and hydrostatic pressures of the Starling Law, on the basis of what they could be compared with, demonstrating that their sensitivity levels and their specificity may be used as positive or negative predictive values in the discriminative evaluations of ascites in relation to its probable etiological causes. Even though the Serum-Ascites Albumin Gradient may be useful in the separation of ascites cases with portal hypertension, it is also useful for classifying exudates and transudates. However, the other parameters must not be excluded for the evaluation of those cases, aiming at establishing whether the peritoneum has been affected and hence the terms transudates and exudates should still be used on the basis of the high sensitivity value and specificity of theses tests, which do not differentiate them statistically from the Serum-Ascites Albumin Gradient. Using the cut-off points for each parameter, the most adequate for our population would be 1.5 gr/dl for Albumin and 2.5 gr/dl for protein, with the additional lower cost benefit.
