scholarly journals Differentiating transudative and exudative pleural effusion by pleural fluid cholesterol

2019 ◽  
Vol 1 (1) ◽  
pp. 5-8
Author(s):  
Ayyali Ambresh ◽  
Mallanna S Mulimani
Keyword(s):  
Pleural Effusion ◽  
Blood Sample ◽  
Pleural Fluid ◽  
Correct Diagnosis ◽  
Cost Effective ◽  
Underlying Disease ◽  
Diagnostic Value ◽  
Pleural Effusions ◽  
Biochemical Tests ◽  
Cross Sectional

Background: Pleural effusion is one of the common condition encountered in day to day practise. Pleural effusions represent a very common diagnostic task to the physician. A correct diagnosis of the underlying disease is essential to rational management. Today there are a number of laboratory tests available to differentiate exudates and transudates which are considered cost effective to the patients, so this study was designed for the measurement of pleural fluid cholesterol to differentiate transudative and exudative pleural effusions (sensitivity-97.8%, specificity-100%) with the advantage that a contemporary blood sample is not required, thereby lowering cost of diagnostic procedure. Objectives: To study the diagnostic value of Pleural fluid Cholesterol in differentiating transudative and exudative pleural effusions. Methodology: This cross sectional descriptive study was conducted on patients of pleural effusion (n=60)age >18 years patients with definitive clinical diagnosis and evidenced by radiological diagnosis of pleural effusion were taken as inclusion criteria. Results: The results showed majority of the patients were males (63.3%) and females (36.7%). According to lights criteria 46 patients were exudates and 14 patients were transudates and according to Pleural fluid Cholesterol criteria 45 patients were exudates and 15 patients were transudates with sensitivity of 97.8% and specificity of 100% and accuracy of 98.3%.Conclusion: The pleural fluid cholesterol criteria were found to be the most efficient criteria. Since this parameter involves the measurement of only pleural fluid values of cholesterol, it has following advantages-Economically it reduces number of biochemical tests and Simpler as there is no need to take simultaneous blood sample at the time of thoracocentesis.

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 Use of C-reactive protein level in diagnosis of tubercular pleural effusion

2019 ◽  
Vol 8 (1) ◽  
pp. 20-23
Author(s):  
Subash Pant ◽  
Sanjeet Krishna Shrestha ◽  
Lucky Sharma ◽  
Bibechana Shrestha
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Protein Level ◽  
College Teaching ◽  
C Reactive Protein ◽  
Biochemical Tests ◽  
Cross Sectional ◽  
Female Ratio ◽  
Protein Levels ◽  
Reactive Protein

Background: C-reactive protein in both pleural fluid and serum has been found to be higher in tubercular pleural effusion than in other causes of pleural effusion. Objectives: The main aim of this study was to find out the diagnostic value of C-reactive protein in patients withlymphocytic pleural effusion. Methodology: A cross-sectional study was conducted in 90 patients with pleural effusion who underwent thoracocentesis at Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal. The complete biochemical tests of pleural fluid and serum were performed. The C-reactive protein concentrations of both pleural fluid and serum were then measured from samples from patients with lymphocytic exudative pleural effusion. Results: Ninety patients with exudative lymphocytic pleural effusion were included. Male patients were 56 (62.2%) and female were 34 (37.8%) with the male to female ratio of 1.64. Mean age of the patients was 51±21.54 (Mean ± Standard Deviation). The pleural fluid C-reactive protein levels in tubercular pleural effusion were higher (48.87±24.19 mg/dl) compared to non-tubercular group (38.30±17 mg/dl; p<0.001). Similarly, the serum fluid C-reactive protein levels in tubercular pleural effusion were higher (29.60±13mg/dl) compared to non-tubercular group (18.14±9.2mg/dl; p< 0.001). The sensitivity of pleural fluid C-reactive protein level in diagnosing tubercular pleural effusion was 86%. Conclusion: Simple and inexpensive test like C-reactive protein is useful in the diagnostic workup of lymphocytic pleural effusions. High C-reactive protein levels are very suggestive of tubercular pleural effusion.

Determination of tissue polypeptide-specific antigen in pleural fluid and serum from patients with pleural effusion

1995 ◽  
Vol 10 (3) ◽  
pp. 161-165 ◽  
Author(s):  
V. Villena ◽  
J. Echave-Sustaeta ◽  
A. Lopez-Encuentra ◽  
P. Martin-Escribano ◽  
J. Estenoz-Alfaro ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Sensitivity And Specificity ◽  
Specific Antigen ◽  
Diagnostic Value ◽  
Pleural Effusions ◽  
Malignant Pleural Effusions ◽  
Cytologic Analysis

As a tool for differentiating malignant and benign pleural effusions, we evaluated the diagnostic value of the assay of tissue polypeptide-specific antigen (TPS) in pleural fluid and serum, and of the pleural fluid TPS/serum TPS ratio in patients with pleural effusion. We studied prospectively 147 consecutive patients who had pleural effusions: 43 malignant pleural effusions and 104 benign pleural effusions. TPS levels were measured by RIA. The sensitivity and specificity of these measurements were: TPS in pleural fluid (cutoff 20,000 U/L): 0.21 and 0.98; TPS in serum (cutoff 300 U/L): 0.31 and 0.96; pleural fluid TPSI serum TPS ratio (cutoff 1200): 0.07 and 0.99. All these values enhanced the sensitivity of cytologic analysis of pleural fluid. However, we conclude that TPS assay in pleural fluid and serum, and the pleural fluid TPSI serum TPS ratio have limited diagnostic value in patients with pleural effusion.

scholarly journals Potential diagnostic value of pleural fluid cytokines levels for tuberculous pleural effusion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Neda Dalil Roofchayee ◽  
Majid Marjani ◽  
Neda K. Dezfuli ◽  
Payam Tabarsi ◽  
Afshin Moniri ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Diagnostic Value ◽  
Parapneumonic Effusion ◽  
Pleural Effusions ◽  
Tuberculous Pleural Effusion ◽  
New Biomarkers ◽  
High Level

AbstractPatients with tuberculous pleural effusion (TPE) or malignant pleural effusions (MPE) frequently have similar pleural fluid profiles. New biomarkers for the differential diagnosis of TPE are required. We determined whether cytokine profiles in the PE of patients could aid the differential diagnosis of TPE. 30 patients with TPE, 30 patients with MPE, 14 patients with empyema (EMP) and 14 patients with parapneumonic effusion (PPE) were enrolled between Dec 2018 and 2019. The levels of interleukin (IL)-6, IL-18, IL-27, CXCL8, CCL-1 and IP-10 were determined in PE by ELISA along with measurements of adenosine deaminase (ADA). The best predictors of TPE were combined ADA.IL-27 [optimal cut-off value = 42.68 (103 U ng/l2), sensitivity 100%, specificity 98.28%], ADA [cut off value 27.5 (IU/l), sensitivity 90%, specificity 96.5%] and IL-27 [cut-off value = 2363 (pg/ml), sensitivity 96.7%, specificity 98.3%, p ≤ 0.0001]. A high level of IL-6 [cut-off value = 3260 (pg/ml), sensitivity 100%, specificity 67.2%], CXCL8 [cut-off value = 144.5 (pg/ml), sensitivity 93.3%, specificity 58.6%], CCL1 [cut-off value = 54 (pg/ml), sensitivity 100%, specificity 70.7%] and IP-10 [cut-off value = 891.9 (pg/ml), sensitivity 83.3%, specificity 48.3%] were also predictive of TPE. High ADA.IL-27, ADA and IL-27 levels differentiate between TPE and non-TPE with improved specificity and diagnostic accuracy and may be useful clinically.

scholarly journals Potential diagnostic value of pleural fluid cytokines levels for tuberculous pleural effusion

2020 ◽  
Author(s):  
Neda Dalil Roofchayee ◽  
Majid Marjani ◽  
Neda K.Dezfuli ◽  
Payam Tabarsi ◽  
Afshin Moniri ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Extrapulmonary Tuberculosis ◽  
Clinical Manifestations ◽  
Diagnostic Value ◽  
Pleural Effusions ◽  
Tuberculous Pleural Effusion ◽  
New Biomarkers ◽  
High Level

Abstract Background: Tuberculous pleural effusion (TPE) is one of the most common forms of extrapulmonary tuberculosis. Patients with tuberculous or malignant pleural effusions (MPE) frequently have similar clinical manifestations and pleural fluid profile. New biomarkers for the differential diagnosis of TPE are required. Objective: We sought to determine of whether cytokine profiles in the pleural effusion of patients were suitable as tools for the differential diagnosis of TPE. Methods: 30 patients with TPE, 30 patients with MPE, 14 patients with empyema and 14 patients with parapneumonic effusion were enrolled consecutively from the Masih Daneshvari Hospital, Tehran, Iran between Dec 2018-Dec 2019. The levels of interleukin (IL)-6, IL-18, IL-27, CXCL-8, CCL-1 and IP-10 were determined in pleural effusions by ELISA along with measurements of adenosine deaminase (ADA). Results: The levels of all analytes measured except IL-18 were higher in TPE compared with non-TPE subjects (all p < 0.01). The best predictors of TPE were combined ADA.IL-27 (optimal cut-off value = 42.68 103.U.ng/L2, sensitivity 100%, specificity 98.28%, p ≤ 0.0001), ADA (optimal cut off value 27.5 IU/L, sensitivity 90%, specificity 96.5%, p ≤ 0.0001) and IL-27 (optimal cut-off value = 2363 pg/ml, sensitivity 96.7%, specificity 98.3%, p ≤ 0.0001). A high level of IL-6 (optimal cut-off value = 3260 pg/ml, sensitivity 100%, specificity 67.2%, p ≤ 0.0001), CXCL-8 (optimal cut-off value = 144.5 pg/m, sensitivity 93.3%, specificity 58.6%, p ≤ 0.0001), CCL-1 (optimal cut-off value = 54 pg/mL, sensitivity 100%, specificity 70.7%, p ≤ 0.0001) and IP-10 (optimal cut-off value = 891.9 pg/mL, sensitivity 83.3%, specificity 48.3%, p = 0.0001) were also predictive of TPE. Conclusion: High ADA.IL-27, ADA and IL-27 levels differentiate between TPE and non-TPE with improved specificity and diagnostic accuracy.

scholarly journals Pleural fluid cholesterol level is an important parameter in differentiating exudative from transudative pleural effusions

2018 ◽  
Vol 5 (3) ◽  
pp. 520
Author(s):  
Chakradhar Majhi ◽  
Butungeshwar Pradhan ◽  
Bikash C. Nanda ◽  
Sagnika Tripathy
Keyword(s):  
Pleural Effusion ◽  
Cholesterol Level ◽  
Pleural Fluid ◽  
Sensitivity And Specificity ◽  
Pleural Effusions ◽  
Biochemical Tests ◽  
Etiological Diagnosis ◽  
Multiple Parameters ◽  
Fluid Analysis ◽  
Cholesterol Levels

Background: The first important step is to decide whether the pleural effusion is transudate or exudates by Light’s criteria. Light’s criteria can misclassify 25% of pleural transudates as exudates. Pleural fluid cholesterol level can differentiate transudates from exudates as a single parameter instead of multiple parameters used in Light’s criteria. Measurement of pleural fluid cholesterol levels to differentiate transudative effusions from exudative effusions.Methods: Consecutive 60 cases of pleural effusion were taken in the study. Pleural fluid analysis was done for parameters of Light’s criteria along with pleural fluid cholesterol levels. First exudative and transudative effusion was classified by Light’s criteria. Other  clinical and relevant  biochemical tests were done to arrive in  the final etiological diagnosis  and data were collected and analysed .Pleural fluid cholesterol levels was  correlated to Light’s criteria.Results: Total 60 cases of pleural effusion were there in the study. There were 43 exudative and 17 transudative effusions. Mean cholesterol level was 64.2± 7.5mg/dl in exudative effusions and 26.05±8.01 mg/dl in transudates. Pleural fluid cholesterol was ≥55mg /dl in 43 cases of exudates and <55mg/dl in 17 cases of transudates.Conclusions: Pleural fluid cholesterol level of ≥ 55mg/dl had similar sensitivity and specificity to Light’s criteria and as a single important parameter to differentiate exudative from transudative pleural effusion

scholarly journals Diagnosis dan tatalaksana terbaru penyakit pleura

2020 ◽  
Vol 2 (1) ◽  
pp. 69-78
Author(s):  
Ni Putu Nita Pranita
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Malignant Pleural Effusion ◽  
Bronchopleural Fistula ◽  
Disease Process ◽  
Standard Of Care ◽  
Underlying Disease ◽  
Pleural Disease ◽  
Pleural Effusions

Pleural effusion is a common problem. Pleural effusion developed as a sequel to the underlying disease process, including pressure/volume imbalance, infection, and malignancy. In addition to pleural effusion, persistent air leak after surgery and bronchopleural fistula remain a challenge by a physician. An understanding of the pleural disease, including its diagnosis and management, has made an extraordinary step. The introduction of molecular detection of organism-specific infections, risk stratification, and improvement in the non-surgical treatment of patients with pleural infection are all within reach and maybe the standard of care shortly. This article discusses the role of existing techniques, and some of the more recent ones, which are now available for establishing the diagnosis of pleural disease. The initial approach to diagnosis usually begins by distinguishing between transudates and exudates, based on the concentration of protein and lactate dehydrogenase (LDH) in pleural fluid. The exact role of amylase and LDH can provide additional information towards the differential diagnosis of various exudative pleural effusions. With newer cytochemical staining techniques in pleural fluid, diagnostic results of malignant pleural effusion can increase by up to 80%. Ultrasound (US) and thoracic computed tomographic (CT) scans have further improved the diagnosis of undiagnosed pleural effusion. The reappearance of thoracoscopy as the latest diagnostic and therapeutic tool (e.g., Pleurodesis) for undiagnosed or recurrent pleural effusions. Management of malignant pleural effusion continues to develop with the introduction of tunneled pleural catheters and chemical pleurodesis procedures. Advances in the diagnostic and therapeutic evaluation of pleural disease and what appears to be an increasing multidisciplinary interest in a doctor managing patients with pleural disease.

scholarly journals Diagnostic Accuracy of Adenosine deaminase enzyme (ADA) in the diagnosis of tuberculous pleural effusion

2020 ◽  
Vol 24 (4) ◽  
pp. 311-315
Author(s):  
Haroon Ur Rasheed ◽  
Ejaz Hassan Khan ◽  
Mohsin Shafi ◽  
Ahmad Rafiq ◽  
Ambreen Ali ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Predictive Value ◽  
Colorimetric Method ◽  
Pleural Effusions ◽  
Cross Sectional ◽  
Tuberculous Pleural Effusion ◽  
Systemic Examination

Objective: To study the diagnostic accuracy of Adenosine deaminase enzyme (ADA) in the diagnosis of tuberculous pleural effusion (TPE).Material and Methods: It was a cross-sectional descriptive study conducted in the Pulmonology departments of Lady Reading and Khyber Teaching Hospital Peshawar and department of Pathology, Khyber Medical College, Peshawar from April 2015 to Jan 2016. A total of 210 tuberculous and non-tuberculous pleural effusion patients were selected through consecutive non-probability sampling techniques. After physical and systemic examination, 3cc of pleural fluid was taken. ADA was estimated by Non-Guisti and Galanti method through the simple colorimetric method. All the data was entered in a specially designed proforma and SPSS v16 was used for statistical analysis.Results: Out of 210 tuberculous and non-tuberculous pleural effusions, the commonest cause of pleural effusion was tuberculosis followed by malignancy. In our study, Pleural fluid ADA levels have sensitivity, specificity, positive predictive value( PPV), and negative predictive value (NPV) of 95.5%, 92.3%, 92.4%, and 96% respectively in differentiating tuberculous pleural effusions from non-tuberculous lymphocytes predominant pleural effusions. Conclusion: Tuberculosis is the commonest infectious disease worldwide. A pleural fluid ADA level of ≥ 35 U/L in lymphocyte-predominant effusions makes mycobacterium tuberculosis most likely etiology. This test is not only very sensitive and specific but also it is very cheap, quick, and easy to perform by routine colorimetric method.  

scholarly journals Role of pleural fluid interleukin-6, neutrophil-lymphocyte ratio, and monocyte-lymphocyte ratio in distinguishing tuberculous and malignant pleural effusions

2021 ◽  
Vol 8 (4) ◽  
pp. 492
Author(s):  
Venny Singgih ◽  
Ketut Suryana ◽  
Ida Ayu Jasminarti Dwi Kusumawardani ◽  
Ni Wayan Candrawati ◽  
I. Gede Ketut Sajinadiyasa ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Pleural Fluid ◽  
Interleukin 6 ◽  
Cross Sectional Study ◽  
Differential Count ◽  
Pleural Effusions ◽  
Cross Sectional ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Malignant Pleural Effusions

Background: Pleural effusion is caused by various disease, including tuberculosis infection and malignancy. To determine the etiology, immunologic parameters are needed to distinguish tuberculous and malignant pleural effusions, including pleural fluid interleukin-6 (IL-6), neutrophil-lymphocyte ratio (NLR), and monocyte-lymphocyte ratio (MLR).Methods: This was a cross-sectional study, conducted at Sanglah General Hospital in Denpasar from March 2020 to September 2020. Pleural fluid IL-6 and leucocyte differential count were measured from subjects with tuberculous and malignant pleural effusions.Results: There were 22 tuberculous pleural effusion subjects with mean pleural fluid IL-6 9269.017±902.211 pg/ml, median (range) pleural fluid NLR 0.123 (0.044-9.449), and MLR 0.065 (0.044-0.355). There were 31 subjects with malignant pleural effusions, with mean pleural fluid IL-6 8212.146±2022.350 pg/ml, median pleural fluid NLR 0.189 (0.015-2.599), and MLR 0.065 (0.010-0.254). Pleural fluid IL-6 in tuberculous pleural effusions were significantly higher (p=0.014). With a pleural fluid IL-6 cut-off ≥9147.959 pg/ml, sensitivity of 63.6% and specificity of 64.5% were obtained. Pleural fluid NLR and MLR of the two groups were not significantly different (p=0.807 and p=0.116).Conclusions: Pleural fluid IL-6 in tuberculous pleural effusions is higher than malignant pleural effusions, with a cut-off of ≥9147.959 pg/ml, tuberculous pleural effusions can be diagnosed with sensitivity of 63.6% and specificity of 64.5%. There is no difference in pleural fluid NLR and MLR in tuberculous and malignant pleural effusions.  

CLINICAL SYMPTOMS, BIOCHEMISTRY AND CYTOLOGY OF PLEURAL, PERITONEAL EFFUSIONS

2016 ◽  
pp. 66-71
Author(s):  
Van Mao Nguyen ◽  
Huyen Quynh Trang Pham
Keyword(s):  
Pleural Effusion ◽  
Clinical Symptoms ◽  
Cross Sectional Study ◽  
Malignant Cells ◽  
Sectional Study ◽  
Pleural Effusions ◽  
Cross Sectional ◽  
Breath Sounds ◽  
Peritoneal Effusion ◽  
Neutrophil Leukocytes

Background: The cytology and the support of clinical symptoms, biochemistry for diagnosis of the cases of effusions are very important. Objectives: - To describe some of clinical symptoms and biochemistry of effusions. - To compare the results between cytology and biochemistry by the causes of pleural, peritoneal fluids. Material & Method: A cross-sectional study to describe all of 47 patients with pleural, peritoneal effusions examinated by cytology in the Hospital of Hue University of Medicine and Pharmacy from April 2013 to January 2014. Results: In 47 cases with effusions, pleural effusion accounting for 55.32%, following peritoneal effusions 29.79% and 14.89% with both of them. The most common symptoms in patients with pleural effusions were diminished or absent tactile fremitus, dull percussion, diminished or absent breath sounds (100%), in patients with peritoneal effusions was ascites (95.24%). 100% cases with pleural effusions, 50% cases with peritoneal effusions and 80% cases with pleural and peritoneal effusions were exudates. The percentage of malignant cells in patients with pleural effusions was 26.92%, in peritoneal effusions was 28.57%, in pleural and peritoneal effusions was 42.86%. The percentage of detecting the malignant cells in patients with suspected cancer in the first test was 57.14%, in the second was 9.53% and 33.33% undetectable. Most of cases which had malignant cells and inflammatory were exudates, all of the cases which had a few cells were transudates. Besides, 7.5% cases which had high neutrophil leukocytes were transudates. Conclusion: Cytology should be carry out adding to the clinical examinations and biochemistry tests to have an exact diagnosis, especially for the malignant ones. For the case with suspected cancer, we should repeat cytology test one more time to increase the ability to detect malignant cells. Key words: Effusion, pleural effusion, peritoneal effusion, cytology, biochemistry

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