Serum Ascites Albumin Gradient (SAAG) Interpretation 

Updated: Dec 05, 2014
  • 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]

  • 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]

  • 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