Evaluation of Different Criteria for the Separation of Pleural Transudates From Exudates

Romero, Santiago; Candela, A; Martín, César Casquet; Hernández, Luís; Trigo, Celia; Gil, Joan

doi:10.1378/chest.104.2.399

Cited by 137 publications

(97 citation statements)

References 12 publications

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“…For this reason, researchers have long been looking for a new parameter both sufficiently sensitive and specific and also easy and cheap to perform. The current study showed 97% sensitivity and 65% specificity, and these figures were consistent with the literature [2,3,4,5,6]. Joseph et al reported sensitivity and specificity of LDH level 377 IU/L or above in pleural fluid as 74% and 83% respectively [7].…”

Section: Discussionsupporting

confidence: 92%

The Comparative Analysis of Biochemical Parameters in Patients with Pleural Effusions: A Prospective Study

Kutluk¹

2017

Ann Clin Anal Med

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ÖzetAmaç: Plevra sıvılarında transuda eksuda ayırımı, sıvının etyolojisi ile ilgili hangi ileri tetkiklerin yapılmasının gerekliligi ve tedavi stratejilerinin belirlenmesi hakkında fikir vermesi nedeniyle önemlidir. Amacımız plevra sı-vılarında transuda eksuda ayırımı için light kriterleri ile birlikte diğer biyokimyasal parametrelerin tanı değerini araştırmaktır. Gereç ve Yöntem: Etyolojisi bilinmeyen plevral effüzyonlu 52 olgunun LDH, total protein, Albumin, ADA, Apolipoprotein A1, Apolipoprotein B, Lipoprotein-a, Kolesterol, HDL-kolesterol, VLDL-kolesterol, LDL-kolesterol ve Trigliserit parametreleri hem plevral sıvı hasta serumlarında eşzamanlı ölçüldü. Gruplar arası karşı-laştırmalarda Mann-Whitney U testi kullanıldı, buna göre p < 0,05 ise anlamlı kabul edildi. Eksüda ve transüda ayrımında her bir biyokimyasal parametrenin duyarlılığı, özgüllük ve etkinliği hesaplandı. Verilerin istatistiksel analizinde her bir test için en iyi kesim değeri ROC eğrisi kullanılarak ortaya çıkar-tıldı, optimum cut-off seviyesi en yüksek toplam duyarlılık ve özgüllük değe-ri oluşan noktadan seçildi Bulgular: Transüda-eksüda ayrımında plevral LDH (p=0,001), Total protein (p=0,001), Albumin (p=0,001), Trigliserit (p=0,001), Kolesterol (p=0,001), HDL-kolesterol (p=0,042), VLDL-kolesterol (p=0,001), LDL-kolesterol (p=0,001), Apolipoprotein A1 (p=0,021) ve HDL-kolesterol/ LDL kolesterol oranı (p=0,048) anlamlı olarak tespit edildi. Tartışma: Sonuç olarak bu çalışmada, plevral LDH, kolesterol ve HDL-kolesterol'ün birlikte kullanılması, Light kriterlerindeki değerlerin kullanılmasına göre istatistiki olarak daha anlamlı bulunmuştur. Bu oranlar %99 duyarlılık, %94,1 özgüllük ve %96,2 doğruluk oranlarına sahiptir. Anahtar Kelimeler Plevral Sıvı; HDL; Malign Plevral EffüzyonlarAbstract Aim: The differentiation of exudative from transudative effusion is important to lead the clinician in making further biochemical analysis for possible etiology and in choosing the appropriate treatment strategy. The aim of the study is to evaluate the diagnostic value of biochemical parameters together with Light's criteria to differentiate exudative from transudative effusions. Material and Method: The LDH, total protein, albumin, adenosine deaminase (ADA), apolipoprotein A1, apolipoprotein B, Lipoprotein-A, total cholesterol, HDL-cholesterol, VLDL-cholesterol, LDL-cholesterol, and triglyceride levels of patients with unknown etiology were measured both in plasma and pleural fluid. Mann-Whitney U was used to compare the groups and p < 0.05 was accepted as statistical significance. Sensitivity, specificity, and accuracy were calculated for each biochemical parameter. The ROC analysis was used to estimate the optimum cut-off value for the highest sensitivity and specificity. Results: Pleural LDH (p=0.001), total protein (p=0.001), albumin (p=0.001), triglyceride (p=0.001), total cholesterol (p=0.001), HDL-cholesterol (p=0.042), VLDL-cholesterol (p=0.001), LDL-cholesterol (p=0.001), apolipoprotein A1 (p=0.021), and HDL-cholesterol/LDL-cholesterol ratio (p...

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Section: Discussionsupporting

confidence: 92%

The Comparative Analysis of Biochemical Parameters in Patients with Pleural Effusions: A Prospective Study

Kutluk¹

2017

Ann Clin Anal Med

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“…[1][2][3][4][5][6][7][8][9] In most hospitals, only fluid total protein is measured routinely to classify the fluid as a transudate or an exudate. The measurement of fluid LDH and the fluid to serum protein ratio in ascitic and pleural fluid substantially improves the diagnostic classification of these fluids as transudates or exudates, thus aiding clinical diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Light et al used a fluid to serum total protein ratio > 0.5, a fluid lactate dehydrogenase (LDH) value > 200 U/litre, or a fluid to serum LDH ratio > 0.6 to diagnose exudates, with the remaining fluids being transudates. 1 This has been reported as the best method for discriminating between exudates and transudates, 2 although other workers 3 have modified the cut off points used by Light et al 1 A recent meta-analysis of studies on pleural fluids 4 found that no one test was clearly superior in differentiating exudates from transudates. Although paired and triple tests had higher diagnostic accuracies than individual tests, no clearly superior test combination was identified.…”

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confidence: 99%

New criteria for the differentiation between transudates and exudates

Paramothayan¹,

Barron²

2002

Journal of Clinical Pathology

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Aims: To investigate whether cholesterol and lactate dehydrogenase (LDH) measurements in fluids are more sensitive and specific markers for differentiating between exudates and transudates, as confirmed clinically, than the measurement of fluid total protein concentrations alone. Patients/Methods: Serum, pleural fluid, and ascitic fluid from 61 unselected patients were analysed retrospectively for LDH, cholesterol, and total protein. Clinical classification of transudate or exudate was reached independently by reviewing clinical details and laboratory data. Results: Of 54 samples (40 pleural fluid and 14 ascitic fluid), 30 were classified clinically as exudates and 24 as transudates. Fluid LDH and fluid to serum protein ratio measurements were equally good at differentiating between exudates and transudates, with a sensitivity of 90%, a specificity of 79%, a positive predictive value (PPV) of 84%, and a negative predictive value (NPV) of 86%. A combination of these parameters improved sensitivity to 100% and NPV to 100%, but lowered the specificity to 71% and PPV to 81%. This combination achieved a higher efficiency than Light's criteria. Conclusion: Routine measurement of fluid LDH values and the calculation of fluid to serum total protein ratios will aid in differentiating exudates from transudates.

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“…suits have been conflicting (9,10,16,17). transudates from exudates (1)(2)(3)(4)(5)(6). However, total lactate dehydrogenase activity in the pleural fluid is of little value The aim of this study was to evaluate the possible diagin the discrimination between various types of exudative nostic value of lactate dehydrogenase isoenzymes in the effusions such as malignant from non-malignant effu-analysis of pleural effusions, especially in the differentisions (1,(3)(4)(5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

“…transudates from exudates (1)(2)(3)(4)(5)(6). However, total lactate dehydrogenase activity in the pleural fluid is of little value The aim of this study was to evaluate the possible diagin the discrimination between various types of exudative nostic value of lactate dehydrogenase isoenzymes in the effusions such as malignant from non-malignant effu-analysis of pleural effusions, especially in the differentisions (1,(3)(4)(5)(6)(7)(8)(9). Cytoplasmic, cellular enzymes, such as ation between parapneumonic (effusions caused by a lactate dehydrogenase in the extracellular space are sug-pneumonic infection with negative bacterial cultures of gestive indicators for disturbances of the cellular integrity the pleural effusion) and malignant effusions (effusions induced by pathological conditions.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Lactate Dehydrogenase Isoenzyme Pattern in Pleural Effusions

Cobben¹,

Belle²,

Pennings³

et al. 1997

Clinical Chemistry and Laboratory Medicine

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Summary: Lactate dehydrogenase isoenzymes have been used to classify the nature of pleural effusion. Nevertheless, studies have reported conflicting results. The objective of this study was to evaluate the diagnostic value of lactate dehydrogenase isoenzymes in the analysis of pleural effusions.Pleural fluid samples obtained from three respective diagnostic groups: group I transudate (n = 23), group II parapneumonic effusion (n = 29) and group III malignant effusion or pleuritis carcinomatosa (n = 41) were evaluated.Total lactate dehydrogenase activity and lactate dehydrogenase (LDH) isoenzyme pattern were significantly different between transudative (group I) and exudative (group II and III) effusions. Group II and III showed a low percentage of LDH 1 (p < 0.001), whereas the percentages of LDH4 (p < 0.001) and LDH5 (p < 0.001) were higher compared to group I. Moreover, in exudative effusions the percentage of LDH1 (p < 0.005), LDH4 (p < 0.005), as well as LDH5 (p < 0.005) were significantly different between parapneumonic and malignant effusions. In contrast to relative lactate dehydrogenase isoenzyme values, the absolute values of lactate dehydrogenase isoenzymes did not differ between group II and group III. Logistic regression analysis yielded a strong discrimination between group I and 11+III, simultaneously using lactate dehydrogenase, glucose and protein as explanatory variables. Logistic regression analysis yielded only a weak discrimination between group II and III, simultaneously using lactate dehydrogenase, glucose and the absolute values of LDH2 and LDH4 as explanatory variables.In conclusion, the lactate dehydrogenase isoenzyme pattern differed between pleural effusions of transudative and exudative origin. However, including lactate dehydrogenase isoenzyme activities in the biochemical work-up of pleural effusions did not reveal an additional discriminatory value in the assessment of the classification of these effusions.

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Evaluation of Different Criteria for the Separation of Pleural Transudates From Exudates

Cited by 137 publications

References 12 publications

The Comparative Analysis of Biochemical Parameters in Patients with Pleural Effusions: A Prospective Study

The Comparative Analysis of Biochemical Parameters in Patients with Pleural Effusions: A Prospective Study

New criteria for the differentiation between transudates and exudates

Diagnostic Value of Lactate Dehydrogenase Isoenzyme Pattern in Pleural Effusions

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