Lactate dehydrogenase, creatine kinase, and their isoenzymes in pleural effusions

1991 ◽  
Vol 37 (11) ◽  
pp. 1909-1912 ◽  
Author(s):  
T Paavonen ◽  
K Liippo ◽  
H Aronen ◽  
U Kiistala
Keyword(s):  
Creatine Kinase ◽  
Lactate Dehydrogenase ◽  
Protein Content ◽  
Pleural Fluid ◽  
Clinical Diagnosis ◽  
Body Fluids ◽  
Pleural Effusions ◽  
Inflammatory Lesions ◽  
Malignant Effusions ◽  
The Mean

Abstract Lactate dehydrogenase (LD; EC 1.1.1.27) and creatine kinase (CK; EC 2.7.3.2) are widely distributed cytoplasmic enzymes. LD has five and CK has three isoenzymes distributed in different proportions in various tissues. The amounts of LD and CK and the distribution of isoenzymes in different body fluids are not thoroughly characterized. We have measured the total LD and CK concentrations and their isoenzyme distribution in pleural aspirates and in serum from 22 patients with benign conditions and from 14 patients with malignant effusions. In malignant pleural fluid, the mean total LD was 662 U/L; in benign conditions, it was nearly 5840 U/L with large variations (91-43 400 U/L) according to clinical diagnosis, the highest values being reached in inflammatory lesions. The mean total CK concentration in pleural fluid was close to the serum value in both groups of patients, as was the pleural CK isoenzyme distribution. The LD isoenzyme distribution in pleural effusions differed from that in serum in both groups, with LD-4 and -5 being the main isoenzymes in their pleural fluid specimens (greater than 42% of total LD). The total LD concentration correlated somewhat (r = 0.57) with the total pleural protein content. In conclusion, the pleural LD isoenzyme distribution, both in benign and malignant conditions, differs from that in serum, having shifted towards more anaerobic and embryonic isoenzymes (LD-4 and -5). Moreover, the greater the concentration of pleural total LD, the greater the proportion of LD-4 and -5. These data suggest that visceral or parietal pleural cells are rich in LD isoenzymes 4 and 5.

scholarly journals Hyaluronic acid levels are increased in complicated parapneumonic pleural effusions

2015 ◽  
Vol 75 (3) ◽  
Author(s):  
T. Zaga ◽  
D. Makris ◽  
I. Tsilioni ◽  
T. Kiropoulos ◽  
S. Oikonomidi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Extracellular Matrix ◽  
Congestive Heart Failure ◽  
Hyaluronic Acid ◽  
Pleural Fluid ◽  
Inflammatory Process ◽  
Serum Levels ◽  
Pleural Effusions ◽  
Tnf Α ◽  
Malignant Effusions

Background and Aim. Hyaluronic acid (HA) is a component of extracellular matrix and may play a role in the pleural inflammation which is implicated in parapneumonic effusions.The aim of the current study was to investigate HA levels in serum and pleura in patients with parapneumonic effusions. Methods. We prospectively studied pleural and serum levels of HA in 58 patients with pleural effusions due to infection (complicated and uncomplicated parapneumonic effusions), malignant effusions and transudative effusions due to congestive heart failure. In addition to HA, TNF-α and IL-1β levels were determined in pleural fluid and serum by ELISA. Results. The median±SD HA levels (pg/ml) in pleural fluid of patients with complicated effusions (39.058±11.208) were significantly increased (p<0.005), compared to those with uncomplicated parapneumonic effusions (11.230±1.969), malignant effusions (10.837±4.803) or congestive heart failure (5.392±3.133). There was no correlation between pleural fluid and serum HA values. Pleural fluid TNF-α levels (146±127 pg/mL) and IL-1β levels (133.4±156 pg/mL) were significantly higher in patients with complicated parapneumonic effusions compared to patients with other types of effusion (p<0.05). No significant association between HA and TNF-α or IL-1β was found. Conclusions. HA may play a significant role in the inflammatory process which characterises exudative infectious pleuritis. Further investigation might reveal whether HA is a useful marker in the management of parapneumonic effusions.

Pleuraerguss: Vereinfachte Kriterien zur Unterscheidung zwischen Exsudat und Transsudat

2019 ◽  
Vol 7 (6) ◽  
pp. 331-332
Author(s):  
Franz Stanzel
Keyword(s):  
Lactate Dehydrogenase ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Likelihood Ratio ◽  
Validation Cohort ◽  
Characteristic Curve ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Serum Lactate Dehydrogenase ◽  
Pleural Effusions

Background: An important part of the investigation of pleural effusion is the identification of markers that help separate exudate from transudate. Objectives: The purposes of this study were to compare the accuracy of published and new sets of criteria to distinguish between exudative and transudative pleural effusions, and to determine whether serum biochemical analysis is necessary. Methods: An externally validated cohort study was performed. Pleural effusions were determined to be transudative or exudative on the basis of an assessment of the medical record by two clinicians blinded to biochemical results. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating characteristic curve were determined for each proposed combination of criteria. Results: Pleural fluid analysis was available for 311 thoracenteses in the main cohort and for 112 thoracenteses in the validation cohort. The best sensitivity (97% [95% CI 94-99]) and negative likelihood ratio (0.04 [95% CI 0.02-0.08]) for identifying exudative effusions were observed with criteria combining pleural fluid lactate dehydrogenase greater than 0.6 the upper limit of normal serum lactate dehydrogenase and pleural fluid cholesterol greater than 1.04 mmol/L (40 mg/dL). The overall diagnostic accuracy was similar to Light's criteria. Findings were similar in the validation cohort. Conclusions: Our proposed criteria using simultaneously pleural fluid lactate dehydrogenase and pleural fluid cholesterol can identify an exudate with a sensitivity and an overall diagnostic accuracy similar to Light's criteria. It avoids simultaneous blood sampling, thus reducing patient discomfort and potential costs.

scholarly journals Study on Oxidative Metabolic Changes to Differentiate Exudative from Transudative Pleural Effusions

1970 ◽  
Vol 1 (1) ◽  
pp. 38-43
Author(s):  
V Narsimha Reddy ◽  
V Anil Kumar ◽  
M Srinivas ◽  
V Narayana Reddy
Keyword(s):  
Oxidative Stress ◽  
Lactate Dehydrogenase ◽  
Pleural Fluid ◽  
Total Protein ◽  
Biochemical Parameters ◽  
Oxygen Species ◽  
Pleural Effusions ◽  
Glucose Levels ◽  
Protein Serum ◽  
Serum Ratio

The purpose of this present study was to differentiate transudates and exudates in pleural effusions. Oxidative stress has been associated with various respiratory disorders. Ninety patients of pleural effusions of diverse etiologies were participated in this study. Subjects underwent diagnostic thoracentesis and standard biochemical parameters (total protein, lactate dehydrogenase, glucose, MDA levels) were measured in pleural fluid and serum. MDA, total protein, lactate dehydrogenase (LDH), glucose levels in plural fluid were higher in exudates compared to transudates (p < 0.001). Total protein pleural fluid/ total protein serum ratio, LDH pleural fluid/LDH serum ratio and MDA pleural fluid/MDA serum ratio were raised in exudates compared to transudates (p < 0.001). The present study showed that oxidative stress was more in exudates compared to transudates, probably due to the production of reactive oxygen species and it may serve as a marker for differentiation between transudates and exudates in clinical practice. Key Words: Exudates, Melondialdehyde, Oxidative Stress, Pleural Effusion, Transudates    doi:10.3329/sjps.v1i1.1806 S. J. Pharm. Sci. 1(1&2): 38-43

Simplified Criteria Using Pleural Fluid Cholesterol and Lactate Dehydrogenase to Distinguish between Exudative and Transudative Pleural Effusions

Respiration ◽  
2019 ◽  
Vol 98 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Pierre-Alexis Lépine ◽  
Rajesh Thomas ◽  
Sébastien Nguyen ◽  
Yves Lacasse ◽  
Hui Min Cheah ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Pleural Fluid ◽  
Pleural Effusions

The Utility of Pleural Fluid Lactate Dehydrogenase to Adenosine Deaminase Ratio in Pleural Tuberculosis

Respiration ◽  
2020 ◽  
pp. 1-5
Author(s):  
Amanda Beukes ◽  
Jane Alexandra Shaw ◽  
Andreas H. Diacon ◽  
Elvis M. Irusen ◽  
Coenraad F.N. Koegelenberg
Keyword(s):  
Lactate Dehydrogenase ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Operating Characteristic ◽  
Retrospective Studies ◽  
Characteristic Curve ◽  
Diagnostic Efficiency ◽  
Pleural Tuberculosis ◽  
High Incidence ◽  
The Mean

In high-burden settings, the diagnosis of pleural tuberculosis (TB) is frequently inferred in patients who present with lymphocyte predominant exudative effusions and high adenosine deaminase (ADA) levels. Two recent small retrospective studies suggested that the lactate dehydrogenase (LDH)/ADA ratio is significantly lower in TB than in non-TB pleural effusions and that the LDH/ADA ratio may be useful in differentiating pleural TB from other pleural exudates. We compared the pleural LDH/ADA ratios, ADA levels, and lymphocyte predominance of a prospectively collected cohort of patients with proven pleural TB (<i>n</i> = 160) to those with a definitive alternative diagnosis (<i>n</i> = 68). The mean pleural fluid LDH/ADA ratio was lower in patients with pleural TB than alternative diagnoses (6.2 vs. 34.3, <i>p</i> &#x3c; 0.001). The area under the receiver operating characteristic curve was 0.92 (<i>p</i> &#x3c; 0.001) for LDH/ADA ratio and 0.88 (<i>p</i> &#x3c; 0.001) for an ADA ≥40 U/L alone. A ratio of ≤12.5 had the best overall diagnostic efficiency, while a ratio of ≤10 had a specificity of 90% and a positive predictive value of 95%, with a sensitivity of 78%, making it a clinically useful “rule in” value for pleural TB in high incidence settings. When comparing the LDH/ADA ratio to an ADA level ≥40 U/L in the presence of a lymphocyte predominant effusion, the latter performed better. When lymphocyte values are unavailable, our data suggest that the LDH/ADA ratio is valuable in distinguishing TB effusions from other pleural exudates.

scholarly journals Application of Computed Tomography (CT) Attenuation Values in Diagnosis of Transudate and Exudate in Patients with Pleural Effusion

2018 ◽  
Vol 11 (02) ◽  
pp. 19-25
Author(s):  
Keshab Sharma ◽  
PS Lamichhane ◽  
BK Sharma
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Ct Scan ◽  
Pleural Fluid ◽  
Pleural Effusions ◽  
Hounsfield Units ◽  
Fluid Analysis ◽  
Ct Attenuation ◽  
The Mean ◽  
Attenuation Values

Background: Pleural effusion is the pathologic accumulation of fluid in the pleural space. The fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Analysis of pleural fluid by thoracentesis with imaging guidance helps to determine the cause of pleural effusion. The purpose of this study was to assess the accuracy of computed tomography (CT) in characterizing pleural fluid based on attenuation values and CT appearance. Materials and Methods: This prospective study included 100 patients admitted to Gandaki Medical College and Teaching Hospital, Pokhara, Nepal between January 1, 2017 and February 28, 2018. Patients who were diagnosed with pleural effusion and had a chest CT followed by diagnostic thoracentesis within 48 hours were included in the study. Effusions were classified as exudates or transudates using laboratory biochemistry markers on the basis of Light’s criteria. The mean attenuation values of the pleural effusions were measured in Hounsfield units in all patients using a region of interest with the greatest quantity of fluid. Each CT scan was also reviewed for the presence of additional pleural features. Results: According to Light’s criteria, 26 of 100 patients with pleural effusions had transudates, and the remaining patients had exudates. The mean attenuation of the exudates (16.5 ±1.7 HU; 95% CI, range, -33.4 – 44 HU) was significantly higher than the mean attenuation of the transudates (11.6 ±0.57 HU; 95% CI, range, 5 - 16 HU), (P = 0.0001). None of the additional CT features accurately differentiated exudates from transudates (P = 0.70). Fluid loculation was found in 35.13% of exudates and in 19.23% of transudates. Pleural thickening was found in 29.7% of exudates and in 15.3% of transudates. Pleural nodule was found in 10.8% of exudates which all were related to the malignancy. Conclusion: CT attenuation values may be useful in differentiating exudates from transudates. Exudates had significantly higher Hounsfield units in CT scan. Additional signs, such as fluid loculation, pleural thickness, and pleural nodules were more commonly found in patients with exudative effusions and could be considered and may provide further information for the differentiation.

scholarly journals Assessment of the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions

Bionatura ◽  
2021 ◽  
Vol 3 (3) ◽  
pp. 1944-1947
Author(s):  
Hanie Raji ◽  
Seyed Hamid Borsi ◽  
Mehrdad Dargahi MalAmir ◽  
Ahmad Reza Asadollah Salmanpour
Keyword(s):  
Pleural Effusion ◽  
Tumor Marker ◽  
Pleural Fluid ◽  
Tumor Markers ◽  
Low Cost ◽  
High Specificity ◽  
Diagnostic Value ◽  
Pleural Effusions ◽  
Cross Sectional ◽  
The Mean

Pleural effusion is divided into exudative and transudative effusion, and the distinction between exudate and transudate requires multiple investigations of biochemical parameters and their comparison in pleural fluid and serum. This study aimed to assess the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions. This epidemiological and cross-sectional study was performed on 50 patients aged between 18 to 90 years with the diagnosis of exudative pleural effusion referred to Imam Khomeini Hospital in Ahvaz in 2018 and 2019. Demographic and clinical information of patients were collected. The pleural effusion was diagnosed based on physical examination and chest radiography. Pleural effusion was confirmed by thoracentesis. A pleural fluid sample was taken from all patients, and the levels of CEA, CA125, and CRP markers were measured in the pleural fluid. Differentiation of transudate and exudate pleural effusions was performed using Light criteria. The mean CEA and CA125 level of pleural fluid were significantly higher, and the mean CRP level of pleural fluid was significantly lower in patients with malignant diagnoses (P <0.05). Cut-off value with highest sensitivity and specificity in differentiating types of exudative pleural effusions was obtained for CEA tumor marker (greater than 49.8), CA125 tumor marker (greater than 814.02), and CRP marker (less than 7.56). Also, in differentiating types of exudative pleural effusions, CEA tumor marker had sensitivity (89.03%) and specificity (78.42%); CA125 tumor marker had sensitivity (53.18%) and specificity (62.44%), and CRP marker had sensitivity (82.16%), and specificity (89.05%) were. Although the tumor markers had high specificity in the present study, the low sensitivity of some of these tumor markers reduced their diagnostic value. On the other hand, given the numerous advantages of tumor markers, such as low cost and non-invasive, combining them with another can increase the diagnostic value and accuracy.

scholarly journals STUDY OF PLEURAL FLUID TO SERUM CHOLINESTERASE RATIO TO DIFFERENTIATE BETWEEN TRANSUDATE AND EXUDATE AND ITS CORRELATION WITH LIGHT'S CRITERIA

2020 ◽  
pp. 29-31
Author(s):  
Manohar MR ◽  
Deepti Shetty ◽  
Vikram VM
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Clinical Condition ◽  
Mean Value ◽  
Serum Cholinesterase ◽  
P Value ◽  
Good Sensitivity ◽  
Pleural Effusions ◽  
Exclusion Criteria ◽  
The Mean

Background: Pleural effusion is a common clinical condition faced in everyday practice. The first step in the management of pleural effusion is its differentiation into transudates and exudates. Light’s criteria is the most widely used parameter to differentiate pleural effusions but studies have shown that Light’s criteria misclassifies a significant amount of cases. Methods: Study included 125 patients who had pleural effusion who met the inclusion and exclusion criteria. Duration of the study was 12 months. Results: Accordingly the mean value of this ratio was 0.10 + 0.05 in the transudates group and 0.39 + 0.14 in the exudates group. This difference was found to be statistically significant (p-value < 0.001). This ratio misclassified 5 cases. Among them 2 (3.2%) were transudates that were misdiagnosed as exudates and 3 (4.8%) were exudates that were misdiagnosed as transudates.In this study Light’s criteria misclassified 13 cases in total with a sensitivity of 91.9% and a specificity of 87.3%. Conclusions: Light’s criteria has a good sensitivity and specificity but P/S ChE was the most efficient parameter in differentiating between transudates and exudates in this study.

scholarly journals Isolation of Aurantimonas altamirensis from pleural effusions

2010 ◽  
Vol 59 (9) ◽  
pp. 1126-1129 ◽  
Author(s):  
Carlos J. Téllez-Castillo ◽  
Damiana González Granda ◽  
María Bosch Alepuz ◽  
Valme Jurado Lobo ◽  
Cesareo Saiz-Jimenez ◽  
...  
Keyword(s):  
16S Rrna ◽  
16S Rrna Gene ◽  
Pleural Fluid ◽  
Clinical Diagnosis ◽  
Molecular Level ◽  
Gene Sequencing ◽  
16S Rrna Gene Sequencing ◽  
Rrna Gene ◽  
Pleural Effusions ◽  
Rrna Gene Sequencing

Here we report two cases of isolation of Aurantimonas altamirensis from pleural fluid and blood. The strains were identified by 16S rRNA gene sequencing. A. altamirensis appears to be a rare pathogen involved in unusual infectious processes, and must be isolated and studied at the molecular level for correct clinical diagnosis.

Sign in / Sign up

Export Citation Format

Share Document