Differential Diagnosis Value Of SAAG In Canine Ascites And Clinical Application

Ascites is a common morbid condition in the clinical practice of small anima.Many diseases can lead to the formation of ascites and treatment options vary with the causes of ascites.Therefore,the identification of ascites type is necessary for specific treatment.But it is also the difficulty in clinical diagnosis of ascites type in many case.The traditional method is mainly based on the seepage-leachate classification.Ascites are categorized as a leakage fluid if AFTP<25 g/L,on the contrary(AFTP>25 g/L)it is regarded as an exudate.Through a large number of clinical observations,the differential diagnosis accuracy based on leakage-leakage fluid is not ideal,especially for the diagnosis of mixed ascites caused by two or more etiologies.More medical classification methods have been proposed in recent years,for example serum ascites albumin gradients.Medical research shows that SAAG is closely related to portal pressure and is considered to be a reliable indicator for determining whether a patient suffer from portal hypertension.Accuracy is more as high as 95%.However,in the clinical practice of small animals,the character of ascites was still analyzed and identified using the traditional method of seepage and leakage.At the same time,there was no report on the use of SAAG in the identification of ascites in canine at home and abroad.This study aimed to evaluate the significance of SAAG in the diagnosis of ascites,determine its feasibility in the identification of ascites,then explore its superiority in the identification of ascites in canine compared with the traditional method of seepage-leachate to provide reference for the identification of ascites in canine.Canine were diagnosed and screened with ascites from outpatients of the Animal Clinical Teaching Hospital of Northeast Agricultural University from September 2016 to February 2018 in this study.The serum and ascites of dogs with ascites were simultaneously collected,then serum total protein,serum albumin,and ascites albumin were measured in the serum and ascites.Diagnostic value of each classification and combined with AFTP and SAAG methods for ascites in each group was evaluated using a diagnostic test four-cell table.The ROC curves of ascites total protein and serum ascites albumin gradients were plotted for each group,the area under the curve were calculated,and evaluate the diagnostic efficiency.Data was processed with the statistical software SPSS 20.0,then analyze the differences between groups.P<0.05 was considered significant.The test results showed that among the 51 cases of canine ascites,there were 22 cases of male dogs and 29 cases of female dogs,the maximum age was 17 years,the minimum age was 1 years,the average age was 8.88 3.70 years.The SAAG of three groups of patients with ascites were analyzed,and it was concluded that SAAG is valuable for the identification of ascites in dogs.The average value of the liver cirrhosis group was 15 + 3.01 g/L,the mean value of the heart failure group was 9.81 + 3.02 g/L,the average of the peritonitis group was 3.45 + 2.73 g/L,and the difference of SAAG between each group was very significant(P<0.01).The accuracy of ascites in the diagnosis of cirrhosis with SAAG > 11 g/L was 82.35%,the accuracy of diagnosing cardiogenic ascites by the same standard was 39.22%,the accuracy of identifying ascites with SAAG < 11 g/L as the standard was 74.51%,and the area of ROC under the differential ROC curve(AUC)for the differential diagnosis of cirrhosis ascites was 0.939,and the reliability of the diagnosis was high.The accuracy of using AFTP to identify three groups of ascites was 72.55% in cirrhosis group,80.39% in peritonitis group,50.98% in heart failure group.The area under the ROC curve(AUC)of AFTP for peritonitis and ascites identification was 0.986,and the diagnostic results were very reliable.The sensitivity of cardiac failure ascites in combination with SAAG > 11 g/L and AFTP > 25 g/L was 13.64%,the specificity was 96.55%,and the accuracy was 60.78%.The sensitivity of combined SAAG > 11 g/L and AFTP < 25 g/L for predicting cirrhosis ascites was 94.44%,the specificity was 81.82%,and the accuracy was 86.27%;the combination of SAAG < 11 g/L and AFTP > 25 g/L to predict peritonitis ascites.The sensitivity was 100%,the specificity was 85%,and the accuracy was 88.24%.Through the analysis of the results,the following conclusions were concluded: SAAG has a strong clinical significance for the identification of ascites in canine,and has a good application value for the determination of ascites in cirrhosis.SAAG is more significant than AFTP for differential diagnosis of ascites due to cirrhosis.SAAG can be used as an auxiliary examination for diagnosis of peritonitis and peritonitis.SAAG has limitations in the diagnosis of cardiogenic ascites.Compared with single SAAG and AFTP,the combined use of the two can improve the accuracy,specificity,positive predictive value and negative predictive value of the diagnosis of liver cirrhosis in canine.