Serum-Ascites Albumin Gradient (SAAG)

Calculate the SAAG to classify ascites as portal hypertensive (≥ 1.1 g/dL) or non-portal hypertensive (< 1.1 g/dL).

For educational and clinical reference. Not a substitute for medical judgment. See the medical disclaimer.
SAAG
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Interpretation
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References

  1. Runyon BA, Montano AA, Akriviadis EA, et al. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med. 1992;117(3):215-220.
  2. AASLD Practice Guidelines: Management of Adult Patients With Ascites Due to Cirrhosis. 2021 update.

How to use

  1. Enter serum albumin and ascitic fluid albumin (both g/dL).
  2. SAAG and interpretation update instantly.
  3. Always draw both samples at the same time.

Frequently asked questions

What is SAAG?

Serum-Ascites Albumin Gradient: SAAG = serum albumin − ascitic fluid albumin. It classifies ascites better than the older transudate/exudate concept.

How is SAAG interpreted?

SAAG ≥ 1.1 g/dL: ascites due to portal hypertension (cirrhosis, heart failure, Budd-Chiari, etc.). SAAG < 1.1 g/dL: non-portal hypertensive ascites (peritoneal carcinomatosis, TB, pancreatitis, nephrotic syndrome).

When should I tap ascites?

Diagnostic paracentesis is indicated in all new-onset ascites and on admission for cirrhotic patients with ascites to rule out spontaneous bacterial peritonitis.

Should samples be drawn simultaneously?

Yes — serum and ascitic fluid albumin should be drawn at the same time to ensure an accurate gradient.

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