Last Updated: 2001-07-19 13:52:12 EDT Reuters Health
DELHI (Reuters Health) – Esophageal varices are likely to develop in children with cirrhosis if the difference in the albumin levels between serum and ascitic fluid is at least 1.1 g/dL, according to the findings of a study conducted in Jaipur in Western India.
The serum-ascites albumin gradient (SAAG) is a measure of the pressure difference between the portal vein and abdominal cavity, Dr. Bibhuti B. Das from the Lincoln Medical and Mental Health Center in New York City and colleagues explained.
Dr. Das and colleagues measured the SAAG in 26 children with cirrhosis of the liver and ascites who were admitted to the SMS Medical College hospital in Jaipur. The albumin levels were also measured in 14 children with nephrotic syndrome who had ascites.
The researchers observed that the SAAG was equal to or greater than 1.1 g/dL in 22 of the 26 patients with cirrhosis. Upper gastrointestinal endoscopy confirmed the presence of esophageal varices in 20 of these 22 children.
The mean SAAG in children with nephrotic syndrome, and in those with cirrhosis but without varices, was lower than 1.1 g/dL.
"The difference in the mean value of SAAG between nephrotic syndrome and cirrhotic patients with esophageal varices was statistically significant (P = 0.0006)," they write in the June issue of the Indian Journal of Pediatrics. However, the difference in the mean value of SAAG "between nephrotic syndrome and cirrhotic patients without esophageal varices was not (p = 0.83)" statistically significant.
The researchers noted that a SAAG of 1.1g/dl or greater had a sensitivity of 91%, a specificity of 50%, and an efficacy of 85% in diagnosing esophageal varices in children with cirrhosis.
Dr. Das told Reuters Health that although this test has been useful in predicting the presence of varices in adults, its utility has not been previously studied in children. SAAG can be valuable in screening and predicting complications, such as variceal bleeding, and can help identify patients who need referral for upper gastro-intestinal endoscopy, he said.
The researchers conclude that although the study sample was small and the test has its limitations, a "high SAAG [score] is a useful means to predict the presence of esophageal varices in children with ascites," and can assist pediatricians in determining the urgency of care.
Indian J Pediatr 2001;68:511-514.