What does a serum-albumin to ascitic-fluid-albumin ratio greater than 1.1 indicate?

A serum-albumin to ascitic fluid albumin ratio greater than 1.1 is indicative of transudative ascites, which is commonly associated with portal hypertension. This condition often arises from liver cirrhosis, which leads to increased pressure in the portal vein. The high serum albumin compared to the albumin in the ascitic fluid reflects an imbalance in hydrostatic and oncotic pressures that results from systemic issues such as cirrhosis.

In cases of transudative ascites, the fluid is typically clear and has low protein content compared to exudative ascites, which would present with a lower serum to ascitic albumin ratio due to higher protein in the ascitic fluid usually arising from infectious or malignant processes. Hence, when the ratio exceeds 1.1, it suggests that the ascitic fluid is not due to the inflammatory processes typically seen in exudates, further supporting the diagnosis related to portal hypertension rather than malignancy or infection.

While malignancy and heart failure can also cause ascites, their underlying mechanisms typically lead to a different profile, with malignancy resulting in exudative ascites and heart failure tending to cause ascitic fluid with lower albumin levels. Therefore, a ratio greater