Background/Aims
Liver cirrhosis and malignant tumors are two major causes of ascites according to the
reports from Western countries, 80% and 10% respectively. Assuming that there might be regional differences
in etiologies and changes in their frequency over time, we investigated causes of ascites and the diagnostic
usefulness of various laboratory tests. Methods: Medical records of 366 patients, who underwent diagnostic
paracentesis in the mid-1990s (1996 and 1997) and early 2000s (2001 and 2002), were retrospectively reviewed.
The etiology was confirmed by histology, imaging studies, and ascites analyses. Results: The frequency of
cirrhotic ascites was 59.6%, cancer-related 25.7%, tuberculous peritonitis 6.6%, and others 8.1%. Among
cirrhotics, the frequency of cases related to hepatitis B decreased significantly from 72% to 55% over time, and
alcoholic cirrhosis increased from 18% to 34%. Among cancer-related ascites, peritoneal carcinomatosis type
was 75.5% (primary sites: stomach 24.5%, pancreas 15.9%, colon 15.9%, lung 7.4%, etc), metastatic liver
cancers 8.5%, hepatocellular carcinoma without cirrhosis 6.4%, etc. The sensitivity of serum-ascites albumin
gradient for the diagnosis of cirrhotic ascites was 91.4%, and total protein in ascites also revealed a comparable
diagnostic sensitivity, 90%. The diagnostic sensitivity of adenosine deaminase for tuberculous peritonitis was
94.2%, and its positive predictive value was 75%. Conclusions: Liver cirrhosis is the leading cause of ascites,
especially alcoholic cirrhosis has significantly increased. The next common etiology is cancer-related, and its
frequency in Korea is higher than in western countries. Tuberculous peritonitis is still prevalent, and adenosine
deaminase could precisely differentiate it from other causes. (Korean J Hepatol 2007;13:185-195)
