scholarly journals Role of Combined Pleural Fluid Cholesterol and Total Protein in Differentiation of Exudates and Transudates

2020 ◽  
Vol 3 (1) ◽  
pp. 282-285
Author(s):  
Anupam Bista ◽  
Suman Thapa ◽  
Prasant Subedi ◽  
Kiran Manandhar
Keyword(s):  
Pleural Fluid ◽  
Standard Method ◽  
Total Protein ◽  
Gold Standard ◽  
Pleural Effusions

Introduction: Light's criteria had been the standard method for distinguishing exudative and transudative pleural effusions which misidentify 15-20% of transudates as exudates. This study aims to find out the role of combined pleural fluid cholesterol and total protein in distinguishing exudative from transudative pleural effusions and its applicability in Nepalese populations. Materials and Methods: Patients with pleural effusions were enrolled for the study. The combined pleural fluid cholesterol and total protein were compared with Light’s criteria and also compared with the diagnosis on discharge to find out their usefulness in categorizing the pleural effusions. Results: A total of 81 patients enrolled in the study, 42 (51.9%) were male. Based on Light’s criteria, 88.8% pleural effusions were found to be exudates and 11.1% were found to be transudates. Within the criteria, Light’s criteria categorized more pleural fluids as exudates than the diagnosis on discharge. Based on pleural fluid cholesterol >60mg/dL and protein >3g/dL for the classification of exudative and transudative pleural fluid, 62.9% out of 81 samples felled under the exudates and 37.03% pleural effusions under transudates with the sensitivity 87.9% and specificity 100%. Conclusions: Though Light’s criteria remain the gold standard to differentiate transudates and exudates, combined pleural fluid cholesterol and total protein give nearly comparable results without the need for simultaneous blood investigations.

Diagnostic efficacy and suitability of trans-thoracic ultrasonography for pleural fluid detection – The future non-invasive gold-standard?

2020 ◽  
Vol 13 (4) ◽  
pp. 184-190
Author(s):  
Muhammad Irfan ◽  
Abdul Rasheed Qureshi ◽  
Zeeshan Ashraf ◽  
Muhammad Amjad Ramzan ◽  
Tehmina Naeem ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Gold Standard ◽  
Pleural Effusions ◽  
Diagnostic Efficacy ◽  
Chest Sonography ◽  
X Ray ◽  
Non Invasive ◽  
Fluid Detection

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available  and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard.   Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology  OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

The role of pleural fluid thiol/disulphide homoeostasis in the differentiation between transudative and exudative pleural effusions

2021 ◽  
Author(s):  
Nazli Gormeli Kurt ◽  
Servan Gokhan ◽  
Ozcan Erel ◽  
Celal Gunes ◽  
Ahmet Fatih Kahraman ◽  
...  
Keyword(s):  
Pleural Fluid ◽  
Pleural Effusions

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

scholarly journals Pleural tuberculosis

2016 ◽  
Vol 65 (1) ◽  
Author(s):  
B. Chakrabarti ◽  
P.D.O. Davies
Keyword(s):  
Pleural Fluid ◽  
Diagnostic Yield ◽  
Western World ◽  
Pleural Effusions ◽  
Pleural Biopsy ◽  
Biopsy Specimens ◽  
Tuberculous Pleurisy ◽  
The Impact ◽  
Antituberculous Chemotherapy

Pleural effusions in tuberculosis are commonly seen in young adults as an immunological phenomenon occurring soon after primary infection. However, the epidemiology and demographics of tuberculous pleurisy are changing due to the impact of HIV co-infection and the increasing number of pleural effusions seen as part of re-activation disease. Pleural biopsy for histology and culture is the mainstay of diagnosis with closed needle biopsy adequate in the majority of cases. Techniques such as PCR of biopsy specimens and the role of pleural fluid ADA are still being evaluated as a diagnostic aid. Tuberculous empyema is less commonly seen in the western world and the diagnostic yield from pleural fluid here is greater than in “primary” effusions. Treatment with appropriate antituberculous chemotherapy is generally successful though there is currently insufficient evidence to recommend the routine use of corticosteroids in this condition.

scholarly journals Role of Pleural Fluid Albumin in the Exudative Pleural Effusions

CHEST Journal ◽  
2010 ◽  
Vol 138 (4) ◽  
pp. 341A
Author(s):  
Seok-Chul Yang ◽  
Chang-Hoon Lee ◽  
Ho Il Yoon ◽  
Sang-Min Lee ◽  
Jae-Joon Yim ◽  
...  
Keyword(s):  
Pleural Fluid ◽  
Pleural Effusions

scholarly journals The impact of between analytical platform variability on the classification of pleural effusions into exudate or transudate using Light's criteria

2017 ◽  
Vol 70 (7) ◽  
pp. 607-609 ◽  
Author(s):  
Michael P Cornes ◽  
Andrew J Chadburn ◽  
Claire Thomas ◽  
Catherine Darby ◽  
Rachel Webster ◽  
...  
Keyword(s):  
Pleural Fluid ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
Pleural Effusions ◽  
Reference Limit ◽  
Paired Serum ◽  
Upper Reference Limit ◽  
The Impact ◽  
Analytical Platforms

BackgroundLight's criteria are ratios of pleural fluid to serum total protein (TP), pleural fluid to serum lactate dehydrogenase (LDH) and pleural fluid LDH to the upper reference limit for serum LDH. They are used to classify pleural effusions into an exudate or transudate when pleural fluid protein is 25–35 g/L. We evaluated the impact of between analytical platforms on the classification of pleural effusions using Light's criteria.MethodsLight's criteria were used to classify pleural effusions with fluid TP between 25 and 35 g/L into exudate and transudate. LDH and TP were analysed using an Abbott ARCHITECT c16000 analyser using a lactate to pyruvate method for LDH and two Roche Cobas 800 c702 analysers, one using a lactate to pyruvate method (laboratory B) and one a lactate to pyruvate method (laboratory C).ResultsEighty-three paired serum and pleural fluid samples were analysed. Of these, 44 samples had a pleural fluid TP between 25 and 35 g/L and were classified according to Light's criteria. Classification of pleural fluid into transudate or exudate using different analytical platforms was 82% concordant. The LDH ratio and TP ratio were similar in laboratory B and laboratory C, but these were respectively lower (p<0.001) and higher (p<0.001) than those at laboratory A.ConclusionsAlthough Light's criteria are ratios, which should minimise interassay variability, we report 18% discordance between different analytical platforms. The discordance was largely due to the performance of LDH and to a lesser extent protein assays in pleural fluid. Laboratories should be aware that assays may perform differently in serum and pleural fluid.

scholarly journals Quantitative Analysis of Pleural Fluid Cell-free DNA as a Tool for the Classification of Pleural Effusions

2003 ◽  
Vol 49 (5) ◽  
pp. 740-745 ◽  
Author(s):  
Michael H M Chan ◽  
Kai Ming Chow ◽  
Anthony T C Chan ◽  
Chi Bon Leung ◽  
Lisa Y S Chan ◽  
...  
Keyword(s):  
Pleural Fluid ◽  
Roc Curve ◽  
Reference Standard ◽  
Pleural Effusions ◽  
Quantitative Real Time Pcr ◽  
Likelihood Ratios ◽  
Cell Free Dna ◽  
Free Dna ◽  
Fluid Cell

Abstract Background: Recently, much interest has been focused on the quantification of DNA in miscellaneous body fluids. In this study, the application is extended to classifying pleural effusions by measuring cell-free DNA in pleural fluid. Methods: We recruited 50 consecutive patients with pleural effusions with informed consent. Pleural fluids were centrifuged at 13 000g, with supernatants aliquoted for extraction and analysis of β-globin DNA sequence by quantitative real-time PCR. Serum and pleural fluid biochemistries were performed to classify pleural effusions using the modified criteria of Light et al. (Ann Intern Med 1972;77:507–13). The ROC curve was plotted to determine the cutoff DNA concentration for classifying pleural fluids as transudates or exudates. Indicators of diagnostic accuracy were calculated for both pleural fluid DNA and modified criteria of Light et al., using the discharge, microbiologic, and histologic diagnoses as the reference standard. Results: The area under the ROC curve was 0.95 [95% confidence interval (CI), 0.84–0.99]. At 509 genome-equivalents/mL, pleural fluid DNA alone correctly classified 46 of 50 pleural effusions with 91% sensitivity (95% CI, 76–98%), 88% specificity (95% CI, 64–98%), and positive and negative likelihood ratios of 7.7 (95% CI, 3.1–19.5) and 0.10 (95% CI, 0.04–0.27), respectively. With the modified criteria of Light et al., 43 of 50 pleural effusions were correctly classified with 97% sensitivity (95% CI, 91–100%) and 67% specificity (95% CI, 45–89%). There were significant correlations between cell-free DNA and both lactate dehydrogenase and total protein in pleural fluid, suggesting their common origin. Conclusions: Pleural fluid DNA concentrations are markedly increased in exudative effusions, making it a potential new tool to evaluate the etiologic causes of pleural effusions.

scholarly journals A new approach to pleural effusion in cats: Markers for distinguishing transudates from exudates

2009 ◽  
Vol 11 (10) ◽  
pp. 847-855 ◽  
Author(s):  
Andrea Zoia ◽  
Linda A. Slater ◽  
Jane Heller ◽  
David J. Connolly ◽  
David B. Church
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Serum Cholesterol ◽  
Total Protein ◽  
Cholesterol Concentration ◽  
Protein Ratio ◽  
Cholesterol Ratio ◽  
Additional Information ◽  
Paired Samples

Classification of pleural effusion (PE) is central to diagnosis. Traditional veterinary classification has distinguished between transudates, modified transudates and exudates. In human medicine PEs are divided into only two categories: transudates and exudates. The aim of this study was to evaluate, in 20 cats presented with PE, paired samples of serum and pleural fluid for the following parameters: Light's criteria (pleural fluid lactate dehydrogenase concentration (LDHp), pleural fluid/serum LDH ratio, pleural fluid/serum total protein ratio (TPr)), pleural fluid total protein, pleural fluid cholesterol concentration, pleural fluid/serum cholesterol ratio (CHOLr), serum-effusion cholesterol gradient (serum cholesterol minus PE cholesterol concentration (CHOLg)), PE total nucleated cells count (TNCCp) and pleural fluid glucose (GLUp). LDHp and TPr were found most reliable when distinguishing between transudates and exudates, with sensitivity of 100% and 91% and specificity of 100%, respectively. When conflict between the clinical picture and laboratory results exists, calculation of CHOLr, CHOLg and TNCCp measurement may help in the classification of the effusion. Measurement of serum albumin (in the case of a transudate) may provide additional information regarding the pathogenesis of the effusion.

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