We read with interest the recent article by Runyon on diagnosis and treatment of ascites.1
Surprisingly, determination of cholesterol in ascitic fluid was classified as being unhelpful (table 3 of the article). The value of cholesterol in the differentiation between cirrhotic and malignant ascites was first demonstrated in this journal.2 Consequently, we compared cholesterol with other ascitic fluid parameters including the serum-ascites albumin gradient and found it superior.3 Furthermore, we suggested a pathomechanism for the increase of ascitic cholesterol in malignant ascites.4 The diagnostic value of this simple and cheap parameter was confirmed by several groups.5–8 Thus, according to the grading system used in this article, cholesterol should be recommended as Class I, Level B. In our opinion, guidelines should be based on a careful review of the existing literature and free of personal bias. May we suggest that the guidelines be corrected accordingly.