Ascites in acute pancreatitis: A window into disease severity

Figure 2 Selected ascitic fluid parameters with potential diagnostic and prognostic value in acute pancreatitis. Microbiological cultures/PCR are critical for detecting superinfection or infected necrosis. Proinflammatory cytokines (interleukin-6, tumor necrosis factor-alpha) are specific indicators of systemic inflammation and risk of organ failure though less available and more costly. Neutrophil count reflects inflammatory burden and is useful in resource-limited settings. Lactate dehydrogenase is inexpensive and widely available but relatively nonspecific. Glucose and pH at reduced levels suggest infection. Amylase/Lipase support the diagnosis of pancreatic ascites due to ductal disruption. Total protein and albumin characterize the exudative nature and indicate vascular permeability. Serum-ascites albumin gradient differentiates pancreatic ascites from portal hypertension. Cytology excludes malignancy. When interpreted together, combinations such as LDH plus neutrophil count may increase predictive accuracy. IL-6: Interleukin-6; TNF: Tumor necrosis factor; LDH: Lactate dehydrogenase; SAAG: Serum-ascites albumin gradient.