Role of Ascitic fluid Cholesterol in Diagnosis of Different causes of Ascites

Background: Ascites can be difficult to diagnose because it has many causes, including liver cirrhosis, cancer, and tuberculosis. The serum-ascites albumin gradient (SAAG) is commonly used to classify ascites, but it is less reliable in cases of mixed ascites. This study examined how well ascitic fluid cholesterol can distinguish portal hypertensive ascites (PHA) from non-portal hypertensive ascites (NPHA).Aim of study: This study aimed to comprehensively evaluate the diagnostic accuracy of ascitic fluid cholesterol in differentiating various causes of ascites, including cirrhotic, malignant, tuberculous, and cardiac etiologies, within a single, large patient cohort.Methods: We conducted a prospective, observational study of 100 adult patients with ascites of unknown cause at Al-Azhar University Hospitals from November 2024 to October 2025. Patients were divided into two groups based on their SAAG results: Group 1 (PHA, SAAG ≥1.1 g/dL, n=56) and Group 2 (NPHA, SAAG