Background: The differential diagnosis of ascites is a common clinical problem. However, the capability to distinguish malignant from non-malignant causes of ascites using available biochemical techniques
would obviate many expensive and time-consuming diagnostic studies on patients presenting with ascites of unknown etiology. Therefore, this study was planned to evaluate the diagnostic effi cacy of ascitic fl uid cholesterol in comparison to the effi ciency of ascitic/serum total protein, pH, glucose, total leukocyte count, and the serum/ascitic albumin gradient in differentiating “malignant” from non-malignant ascites.
Materials/Methods: A total of 50 patients (25 with malignant ascites and 25 with non-malignant) were evaluated for total ascitic protein, ascites/serum (A/S) total protein ratio, serum ascites albumin gradient (SAAG), ascitic pH, serum & ascitic cholesterol with glucose.
Results: The mean ascitic cholesterol level was signifi cantly higher in malignant ascites than in non-malignant ascites, with a cut off level of 70 mg/dl for ascitic fl uid cholesterol; 22/25 (88%) patients with
malignant ascites could be separated from the 25 patients with non-malignant ascites. The specifi - city (100%) and diagnostic effi ciency (94%) of ascitic fl uid cholesterol is better than the 84% specifi
city and 86% diagnostic effi ciency of serum ascitic albumin gradient.
Conclusions: Total Ascitic protein (70%), Ascitic serum protein ratio (74%), ascitic leukocyte count (54%), and malignant cytology (82%) yielded much lower diagnostic effi ciency than ascitic fl uid cholesterol
(94%) or SAAG (86%) in the diagnosis of malignant ascites.

Keywords: Ascitic Fluid - chemistry, Cholesterol - analysis, Adolescent, Ascites - etiology, Ascitic Fluid - chemistry, Biological Markers - analysis, Cholesterol - analysis, Diagnosis, Differential, Evaluation Studies as Topic, India, Laparotomy, Peritoneal Neoplasms - diagnosis, Predictive Value of Tests