Ascites Albumin Gradient Calculator

How does this ascites albumin gradient calculator work?

This is a health tool that computes the gradient between the two types of albumin substance, the one in the serum and the one is ascites. The resultant gradient is also called SAAG and is determined by the below formula:

SAAG = Serum Albumin – Ascites Albumin

This ascites albumin gradient calculator allows you to input the required values in various units such as g/dL the most common one or g/L, mcg/dL etc. With the result you will be given a brief note on the significance of the SAAG value.

Example calculation

Let’s take the case of a patient with a value of serum albumin of 6.3 g/dL and an ascites albumin value of 8 g/dL. The result is:

■ SAAG = -1.700 g/dL.

■ A high gradient (any SAAG > 1.1 g/dL) indicates portal hypertension and may suggest a nonperitoneal cause of ascites (may indicate conditions such as: cirrhosis, hepatic vein obstruction, fulminant hepatic failure, congestive heart failure, veno-occlusive disease, protein-losing enteropathy, nephrotic syndrome, malnutrition, biliary ascites, ovarian tumors, myxedema, pancreatic ascites, malignancy or trauma).

■ A low gradient (any SAAG < 1.1 g/dL) indicates nonportal hypertension and may suggest a peritoneal cause of ascites (may indicate conditions such as: primary peritoneal mesothelioma, endometriosis, secondary peritoneal carcinomatosis, sarcoidosis, tuberculous peritonitis, fungal and parasitic infections, eosinophilic gastroenteritis, foreign bodies, whipple disease or systemic lupus erythematosus).

Medical implications

- Albumin is a protein made by the liver and its normal serum levels are between 3.4 – 5.4 g/dL.
- Ascites is the definition given to the pathological collection of fluid within the abdominal cavity.
- In a healthy individual the quantity of intraperitoneal fluid varies with the gender. While healthy men have little to none, women can have up to 20 mL in certain phases of the menstrual cycle.
- Cirrhosis is one of the conditions that displays ascites.
- The serum ascites albumin gradient (SAAG) is a basic calculation based on test results that is used to retrieve the etiology of ascites and comes to replace the classic methods of the transudate and exudates. It is recommended that the two albumin levels to be measured closely.

High SAAG conditions

High gradient values that are over 1.1 g/dL are indicative for a nonperitoneal cause of ascites that is due to portal hypertension (the increased hydrostatic pressure in the hepatic portal system). The indicated conditions are the following:

- Cirrhosis of the liver
- Fulminant hepatic failure
- Hepatic vein obstruction
- Congestive heart failure
- Veno-occlusive disease
- Nephrotic syndrome
- Protein-losing enteropathy
- Pancreatic ascites
- Biliary ascites
- Myxedema
- Malignancy

Low gradient conditions

A low SAAG value, lower than 1.1 g/dL is suggestive for a peritoneal cause and excludes increased portal tension. This indicates conditions like those listed below:

- Pancreatitis
- Nephrotic syndrome
- Tuberculosis
- Serositis
- Peritoneal cancers
- Systemic lupus erythematosus
- Fungal and parasitic infections
- Sarcoidosis
- Eosinophilic gastroenteritis
- Endometriosis

References

1) Hou W, Sanyal AJ. (2009) Ascites: diagnosis and management. Med Clin North Am; 93(4):801-17

2) Caldwell SH, Battle EH. (1999) Ascites and spontaneous bacterial peritonitis. Schiff ER, Sorrell MF, Maddrey WC, eds. Schiff's Diseases of the Liver. 8th ed. Philadelphia, Pa: Lippincott-Raven.