Value of Ascitic Lipids in the Differentiation between Cirrhotic and Malignant Ascites

Ascitic fluid concentrations of cholesterol, triglycerides and
phospholipids, were compared with ascitic fluid total protein in 40
patients with chronic liver disease, 51patients with various
neoplasms and 1 patient with cardiac failure. Seven patients
withboth chronic liver disease and malignancy were considered
separately. The first 54 patients (23 cirrhotic and 31 with
malignancy) were used to determine median values and ranges and to
define the most suitable cutoff concentrations between both groups.
Median values for cholesterol (75 mg per dl), phospholipids (0.79
mmole per liter), triglycerides (75 mg per dl) and protein (3.8 gm
per dl)were higher in malignant ascites compared to ascitic fluid
concentrations of cholesterol (20 mg per dl), phospholipids (0.33
mmole per liter), triglycerides (51 mg per dl) and protein (1.9 gm
per dl) in patients withcirrhosis. The best discrimination values
were 48 mg per dl for cholesterol, 0.6 mmole per liter for
phospholipids, 65 mg per dl for triglycerides and 2.5 gm per dl for
protein. Application of these cutoff points to 38 subsequent
patients (17 cirrhotic, 1 with cardiac failure and 20 with
malignancy) revealed an efficiency of 86.8% for cholesterol, 86.8%
for phospholipids, 68.4% for triglycerides and 79.0% for protein.
From the data of all 92 patients, an efficiency of 92.3%
forcholesterol, 79.4% for phospholipids, 72.8% for triglycerides
and 79.4% for protein was calculated. We conclude that ascitic
fluid cholesterol determination offers an excellent, cost-effective
discrimination of ascites due to cirrhosis vs. ascites caused by
malignancies.