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To the Editor Drs Patel and Muir’s JAMA Diagnostic Test Interpretation article1 discussed the evaluation of new-onset ascites, including interpretation of protein and albumin levels in ascitic fluid compared with serum to distinguish among the common causes of ascites—hepatic cirrhosis, heart failure, and peritoneal malignancy. However, their explanation of the underlying pathophysiologic mechanisms in hepatic cirrhosis is not supported by well-substantiated clinical and experimental evidence.2,3
Hearst Witte M. Mechanisms of Ascites Development. JAMA. 2016;316(17):1828–1829. doi:10.1001/jama.2016.15069
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