Frequency and characterization of mixed ascites among cirrhotic patients admitted to Zagazig University hospital

Background and aim. Mixed ascites is definedin patients in whom two or more etiologies of ascites aredemonstrated. Such patients have liver cirrhosis plus (an)other local and/or systemic cause(s). The aimof this workis to detect the frequency and characterization of mixedascites among cirrhotic patients. Patients and methods.The study was conducted on 273 ascitic cirrhotic patients.All patients were subjected to full history taking,thorough clinical examination, radiological investigationsand laboratory investigations including CRP andtumor markers (AFP, CEA, CA 19-9, CA 125).Diagnostic abdominal paracentesis with cytologic andbiochemical analyses and Ziehl- Neelsen staining ofascitic fluid were done. Also, serum-ascites albumingradient (SAAG) was calculated. Results. Twenty eightpatients (10.3%) among the studied patients were mixedascites. Among patients with mixed ascites, the mostcommon cause was malignancy in 11 patients (39.2%),cardiac causes were present in 7 patients (25%), renalcauses were found in 2 patients (7.1%) and surgicalabdominal causes were present in 8 patients (28.7%).Compared to non-mixed ascites, patients with mixed asciteshad a statistically significant increase regarding ascitictotal leucocytic count, SAAG, glucose, lactate dehydrogenaseand protein. Moreover, there was a significantincrease in tumor markers and CRP in patients with mixedascites versus patients with non-mixed ascites. Usinglogistic regression analysis, the predictor variables formixed ascites in cirrhotic patients included positivetumor markers CEA and CA 19-9 and positive CRP.Conclusion. in our study, the commonest cause ofmixed ascites was malignancy. Significant predictors ofmixed ascites were CRP and tumor markers; CEA, CA19-9 and CA 125.