Clinical and Laboratory Characterization of Ascites in a Tertiary Care Setting: A Prospective Observational Study at Hayatabad Medical Complex, Peshawar

Abstract

Background: Ascites, the pathological accumulation of fluid in the peritoneal cavity, is commonly associated with liver cirrhosis; however, in South Asia, tuberculosis and malignancy are also important etiological contributors. Limited regional data exist detailing the clinical and laboratory characteristics of ascites in such high-burden settings, which complicates diagnosis and management. Objective: To evaluate the demographic distribution, clinical features, etiological classification, and diagnostic fluid analysis findings in patients with ascites admitted to a tertiary care center in Peshawar, Pakistan. Methods: A prospective observational study was conducted at Hayatabad Medical Complex from January 2023 to December 2024, enrolling 246 adult patients with clinically and radiologically confirmed ascites. Detailed history, physical examination, serum studies, ascitic fluid analysis (including SAAG, ADA, CEA, PMN count), GeneXpert MTB/RIF testing, ultrasound, and FibroScan were performed. Etiologies were classified using standard diagnostic criteria. Data were analyzed using SPSS version 25. Results: The mean age was 45 years; 83% were male. Cirrhosis was the leading cause (44.7%), followed by tubercular peritonitis (24.4%) and malignancy (12.2%). SAAG >1.1 g/dL was observed in 60.9% of patients. ADA >32 IU/L and GeneXpert positivity supported TB diagnosis in 18.3% and 16.3% respectively. CEA >5 ng/mL was found in 11.4% of cases. Conclusion: In this high-burden setting, cirrhosis remains the predominant cause of ascites, but tuberculosis and malignancy together account for over one-third of cases. Incorporating ADA, GeneXpert, and CEA into diagnostic algorithms improves etiological classification and facilitates targeted management in resource-constrained environments.