Frequency and characterization of mixed ascites among cirrhotic patients admitted to Zagazig University hospital

Document Type : Original article

Authors

1 Tropical Medicine dept., Faculty of Medicine, Zagazig Univ., Zagazig, Egypt

2 Clinical Pathology dept., Faculty of Medicine, Zagazig Univ., Zagazig, Egypt

Abstract

Background and aim. Mixed ascites is defined
in patients in whom two or more etiologies of ascites are
demonstrated. Such patients have liver cirrhosis plus (an)
other local and/or systemic cause(s). The aimof this work
is to detect the frequency and characterization of mixed
ascites among cirrhotic patients. Patients and methods.
The study was conducted on 273 ascitic cirrhotic patients.
All patients were subjected to full history taking,
thorough clinical examination, radiological investigations
and laboratory investigations including CRP and
tumor markers (AFP, CEA, CA 19-9, CA 125).
Diagnostic abdominal paracentesis with cytologic and
biochemical analyses and Ziehl- Neelsen staining of
ascitic fluid were done. Also, serum-ascites albumin
gradient (SAAG) was calculated. Results. Twenty eight
patients (10.3%) among the studied patients were mixed
ascites. Among patients with mixed ascites, the most
common cause was malignancy in 11 patients (39.2%),
cardiac causes were present in 7 patients (25%), renal
causes were found in 2 patients (7.1%) and surgical
abdominal causes were present in 8 patients (28.7%).
Compared to non-mixed ascites, patients with mixed ascites
had a statistically significant increase regarding ascitic
total leucocytic count, SAAG, glucose, lactate dehydrogenase
and protein. Moreover, there was a significant
increase in tumor markers and CRP in patients with mixed
ascites versus patients with non-mixed ascites. Using
logistic regression analysis, the predictor variables for
mixed ascites in cirrhotic patients included positive
tumor markers CEA and CA 19-9 and positive CRP.
Conclusion. in our study, the commonest cause of
mixed ascites was malignancy. Significant predictors of
mixed ascites were CRP and tumor markers; CEA, CA
19-9 and CA 125.

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