Serum Ascites Albumin Gradient (SAAG) Interpretation

Updated: Jan 20, 2023
  • Author: Buck Christensen; Chief Editor: Buck Christensen  more...
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SAAG Interpretation

The serum ascites albumin gradient (SAAG) is a formula used to assist in determining the etiology of ascites. Also see Medscape’s Ascites Albumin Gradient Calculator.

The formula is below.

SAAG = serum albumin – ascites albumin

A high gradient (SAAG >1.1 g/dL) indicates portal hypertension and suggests a nonperitoneal cause of ascites. Such conditions may include the following: [1, 2]

  • Cirrhosis

  • Fulminant hepatic failure

  • Veno-occlusive disease

  • Hepatic vein obstruction (ie, Budd-Chiari syndrome)

  • Congestive heart failure

  • Nephrotic syndrome

  • Protein-losing enteropathy

  • Malnutrition

  • Myxedema

  • Ovarian tumors

  • Pancreatic ascites

  • Biliary ascites

  • Malignancy

  • Trauma

  • Portal hypertension

A low gradient (SAAG < 1.1 g/dL) indicates nonportal hypertension and suggests a peritoneal cause of ascites. Such conditions may include the following: [1, 2]

  • Primary peritoneal mesothelioma

  • Secondary peritoneal carcinomatosis

  • Tuberculous peritonitis

  • Fungal and parasitic infections (eg, Candida, Histoplasma, Cryptococcus, Schistosoma mansoni, Strongyloides, Entamoeba histolytica)

  • Sarcoidosis

  • Foreign bodies (ie, talc, cotton and wood fibers, starch, barium)

  • Systemic lupus erythematosus

  • Henoch-Schönlein purpura

  • Eosinophilic gastroenteritis

  • Whipple disease

  • Endometriosis