Biochemical Markers of Ascitic Fluid to Differentiate Ovarian Cancer from Liver Cirrhosis Patients

Introduction: The pathological accumulation of abdominal fluid (ascites) is due to multiple causes often associated either with peritoneal and non-peritoneal diseases. The differential diagnosis of the above patients is made by biochemical, cytological and imagological methods. Aim: The present study was conducted in serum and ascitic fluid to estimate the levels of Cholesterol, Triglycerides, SATG and SACG along with SAAG to differentiate ascitic patients of ovarian cancer from liver cirrhosis. Materials and Methods: The present prospective crosssectional study was carried out between December 2016 and June 2019 in the Department of Gastroenterology, Osmania General Hospital, Hyderabad, Telangana, India. A total of 375 ascitic patients, (230 patients with liver cirrhosis, 145 ovarian cancer) and 150 age and sex-matched healthy volunteers (hospital working staff and patient's attendant) were enrolled in this study. Serum and ascitic fluid concentrations of Total proteins Total Proteins (TP), Albumin (ALB), Cholesterol (CHOL) and Triglycerides ( TG) were measured by standard methods using the autoanalyzer. Serum Ascitic Albumin Gradient (SAAG), Serum Ascitic Cholesterol Gradient (SACG) and Serum Ascitic Triglycerides Gradient (SATG) were derived by the calculation method. The statistical analysis was conducted by one-way ANOVA; SPSS (version 22). A p-value <0.05 was considered statistically significant. Results: Significantly increased levels of ascitic fluid TP, ALB, CHOL, and TG were observed in ovarian cancer patients when compared to the ascitic fluid of liver cirrhosis (p<0.001). Ascitic fluid total proteins, albumin and SAAG showed the highest diagnostic efficiency (99%) with a sensitivity of (100%) and specificity of 99%. Ascitic fluid CHOL and SATG were also found the highest diagnostic efficiency 95%; 87%; Sensitivity of 93%; 84%. The Area under the curve of CHOL and SATG strongly indicated the diagnostic efficiency of 0.984 and 0.945, respectively. Conclusion: The present study suggested ascitic fluid cholesterol and SATG were found to be the more sensitive parameters that would be used as an additional biomarker along with the SAAG for screening and differential diagnosis of ovarian cancer, to that of liver cirrhosis.