What is SAAG and How is it Used to Determine the Cause of Ascites


There are a number of different health conditions that can adversely affect the overall wellness and quality of life of patients. Some of them can be more life-threatening than others while some may be less risky especially when they are immediately treated or addressed. Fortunately, the advancement in technologies and the improved scientific research in the recent century or so resulted in some pretty accurate medical tests that can provide a clear picture of what illness individuals or patients are suffering from. One such test is known as the SAAG test or the Serum Ascites Albumin Gradient. But what is this for and how is it used? In this article let us first look at what Ascites is and how SAAG can be used to determine the cause of the said condition.

Ascites: A Brief Introduction

An ascites occurs when fluid buildup reaches beyond 25 millimeters (ml) inside the abdominal cavity. This usually occurs when the proper function of the liver is impaired. A malfunction of the liver usually results in the organs and the lining of the abdomen to be filled with fluid. A set of guidelines published in 2010 the survival rate within two years is at around half (50%). For people who believe they are experiencing the symptoms of ascites, it is best to have their symptoms immediately diagnosed and treated by a healthcare professional.

What are the possible causes and risk factors for ascites?

Cirrhosis or the scarring of the liver is the biggest and most common cause for developing and contracting ascites. This is because liver scars can increase the pressure on the blood vessels of the liver. This pressure that is increased can have fluids forced into the abdomen which can lead to ascites.

One of the most major risk factors for the development of ascites is liver damage and this damage to the liver is usually caused by a number of different factors which include excessive use of alcohol, hepatitis B or C, and cirrhosis. Some of the other risk factors that can lead to the development of ascites include hypothyroidism, tuberculosis, pancreatitis, kidney and heart failure, cancer of the liver, pancreas and the ovaries.

When to consider consulting with a doctor?

Ascites symptoms and signs can show up suddenly or gradually depending on the cause of the buildup of fluid. These symptoms do not immediately indicate a medical emergency, but if the following symptoms start to show, then it may be best to consult with your healthcare professional:

  • Heartburn
  • Vomiting and nausea
  • Bloating
  • Pain in the abdomen
  • An appetite that is diminished
  • Breathing difficulties when the patient is lying down
  • Unintentionally gaining weight
  • An abdomen that is swollen or distended.

How ascites are diagnosed

Ascites diagnosis will require a number of steps but the first thing to do is to check the abdomen for any swelling. The doctor may then use other methods of testing or imaging technology to identify the ascites. Some of these tests include angiography, laparoscopy, blood tests, MRI, CT Scan, and ultrasound.

Where does Serum-Ascites Albumin Gradient (SAAG) come in?

SAAG or Serum-Ascites Albumin Gradient (SAAG) is utilized in the field of medicine to aid in determining what caused ascites patients. This method has been observed to a better method to identify which type of ascites fluid is present and identifying ascites as either exudate or transudate. The formula for SAAG is serum albumin minus albumin level of ascitic fluid.

So how is SAAG interpreted? If the SAAG indicates a high gradient (>11g/L, >1.1 g/L) means that there is portal hypertension which can indicate a condition that may be liver or non-liver related and with an accuracy of around 97%. This is mainly due to the hydrostatic pressure of the hepatic portal system’s blood vessels. This can lead to the peritoneal cavity being filled with water but makes proteins like albumin getting left behind in the vasculature. Some of the possible causes of SAAG Ascites that are increased (>11g/L, >1.1 g/L) include idiopathic portal fibrosis, portal vein thrombosis, Budd-Chiari Syndrome, heart failure, and liver cirrhosis.

On the other hand, SAAG Ascites that are considered low gradient (<11 g/L, <1.1 g/L) may indicate that the ascites is caused by other conditions not associated with portal pressure that is increased. These include pulmonary infarcts, peritoneal cancers, serositis, infections, pancreatitis, and tuberculosis.

What are the treatment options for ascites?

Depending on what caused the ascites in the first place, the following treatment options may be utilized:


These are commonly utilized to address ascites and can be one of the most effective treatment options for people with ascites. The drugs can lead to increased water and salt that can leave the body and help in the reduction of pressure within the liver’s veins. While patients are using diuretics, the patient’s healthcare professional will have to conduct monitoring of the patient’s blood chemistry. There is a need to have alcohol intake reduced and also the intake of salt.


This procedure will use a needle that is long to have excess fluid removed. The said needle can be inserted through the patient’s skin to penetrate the cavity of the abdomen. The doctor will also most probably recommend that the patient takes in antibiotics especially since the possibility of an infection is quite high. It may be noteworthy to mention that this kind of treatment may be the most ideal if the ascites is a recurring one. For such cases that are a late-stage, diuretics may not be as effective in handling the said medical condition.


For cases of ascites that are considered extreme, a shunt or a permanent tube may be implanted into the body of the patient. It can help in having the blood rerouted to the liver and mimic a more normal circulation within the body. For end-stage liver disease (ESLD), the doctor may even recommend transplantation of the liver especially if all other treatment options are no longer effective.

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