Serum Ascites Albumin Gradient (SAAG)
Patients with known liver disease and ascites in whom portal hypertension status is unknown.
- The serum ascites albumin gradient (SAAG) can determine which patients with liver disease have portal hypertension.
- A cutoff level of 1.1 has bene validated to determine who has portal hypertension.
Obtaining ascites fluid is relatively simple and safe in experienced operators. The constituents of ascites fluid offer a less-invasive method for gauging risk and portal hypertension status.
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The SAAG seems reliable and useful for determining portal hypertension. It is not as reliable for making pathologic diagnoses, and its value in settings outside of referral populations with liver failure is unknown. Moreover, prospective data are dominated by one SAAG validation study, suggesting future investigations have the potential to shed further light.
We are unaware of validated management algorithms using the SAAG.
The SAAG requires temporally similar blood and ascites fluid examinations.
SAAG = (albumin concentration of serum) – (albumin concentration of ascitic fluid)
Facts & Figures
- SAAG > 1.1 g/dL indicates portal hypertension is the cause of ascites with 97% accuracy.
- SAAG scores do not indicate the cause of the portal hypertension.
Original/Primary ReferenceHoefs JC. The mechanism of ascitic fluid protein concentration increase during diuresis in patients with chronic liver disease. Am J Gastroenterol. 1981 Nov;76(5):423-31. PMID:7337129.
About the Creator
John Carl Hoefs, MD, is a Professor of Medicine at University of California Irvine. He studied medicine at George Washington University in Washington DC. He currently practices and researches in the hepatology field, specifically regarding Hepatitis B, Hepatitis C, Ascites, Chronic liver disease, Liver-spleen scan and Hepatic function.
To view Dr. John Carl Hoefs's publications, visit PubMed