Ascites neopterin, IDO-1 and M2-PK level measurement as an alternative to Acidalbumin Gradient (SAAG) measurement used in etiology research in patients with ascites

Ascites is clinically the result or complication of many diseases and occurs secondary to many causes such as heart diseases, kidney diseases, infection and malignancy. Ascites formation is a poor prognosis indicator and more than 50% of patients die in the 2-year period. Therefore, understanding the etiology of a highly mortal complication such as ascites is essential for appropriate management of the disease. Ascites fluid analysis is the most important step in diagnosis. Although SAAG diagnoses portal hypertension with 97% accuracy, there are results showing that SAAG is not sufficient to differentiate between malignant and non-malignant. In this study, we examined the importance of Neopterin, M2-PK, IDO-1 levels, which have important studies as biomarkers in immune response, inflammatory processes and malignancies and obtained significant results, in determining the etiology of ascites, in comparison with SAAG. In particular, our study showed that low cholesterol (cut-off value of 46 mg/dL) is used to determine the presence of portal ascites, high ferritin (cut-off value of 160 mg/dL) and high neopterin (cut-off value of 2.02 ng/mL) are used in the evaluation of malignant ascites. It suggests that it may be more useful than SAAG. Controlled random clinical studies with a larger population are needed on the subject.