Improving the Predictive Accuracy of Identifying Exudative Effusions

Kummerfeldt, Carlos E.; Chiuzan, Codruța; Huggins, John T.; Divietro, Matthew; Nestor, Jennings; Sahn, Steven A.; Doelken, Peter

doi:10.1378/chest.13-1142

Cited by 12 publications

(5 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As a result, patients misclassified with exudate undergo unnecessary and risky invasive diagnostic procedures, such as thoracoscopic pleural biopsy and image-guided percutaneous pleural biopsy [8]. This highlights the need to develop better methods to differentiate exudative and transudative pleural effusions [9]. …”

Section: Introductionmentioning

confidence: 99%

Can cholesterol be used to distinguish pleural exudates from transudates? evidence from a bivariate meta-analysis

et al. 2014

View full text Add to dashboard Cite

BackgroundMany studies have investigated whether pleural cholesterol levels can aid in diagnosis of pleural exudates, and the results have varied considerably. To gain a more reliable answer to this question, we meta-analyzed the literature on using pleural cholesterol or the ratio of cholesterol in pleural fluid to cholesterol in serum (P/S cholesterol ratio) as diagnostic tests to help identify pleural exudates.MethodsLiterature databases were systematically searched for studies examining accuracy of pleural cholesterol or P/S cholesterol ratios for diagnosing pleural exudates. Data on sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR) were pooled using bivariate-effects models. Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were used to summarize overall test performance.ResultsOur meta-analysis included up to 20 studies involving 3,496 subjects. Summary estimates for pleural cholesterol in the diagnosis of pleural exudates were as follows: sensitivity, 0.88 (95%CI 0.84 to 0.92); specificity, 0.96 (95% CI 0.92 to 0.98); PLR, 20.31 (95% CI 11.21 to 36.78); NLR, 0.12 (95% CI 0.09 to 0.17); DOR, 167.06 (95% CI 76.79 to 363.95); and AUC 0.97 (95% CI 0.95 to 0.98). The corresponding summary performance estimates for using the P/S cholesterol ratio were as follows: sensitivity, 0.94 (95% CI 0.92 to 0.96); specificity, 0.87 (95% CI 0.83 to 0.91); PLR 7.46 (95% CI, 5.47 to 10.19); NLR, 0.07 (95% CI 0.05 to 0.10); DOR, 107.74 (95% CI 60.91 to 190.60); and AUC 0.97 (95% CI 0.95 to 0.98).ConclusionsBoth pleural cholesterol level and the P/S cholesterol ratio are helpful for the diagnosis of pleural exudates. Nevertheless, the results of pleural cholesterol assays should be interpreted in parallel with the results of traditional tests and clinical information.

show abstract

Section: Introductionmentioning

confidence: 99%

Can cholesterol be used to distinguish pleural exudates from transudates? evidence from a bivariate meta-analysis

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Study done by Leers Mathie PG, it was found that pleural cholesterol and pleural LDH had accuracy of 98%, sensitivity of 98% and 95% specificity for diagnosing exudative pleural effusion compared that calculated by light's criteria being accuracy of 93%, sensitivity 100% and specificity 73% [47].…”

Section: Resultsmentioning

confidence: 86%

“…In cases where no cause for an exudative effusion can be identified or CHF suspected, the sequential application of the fluid LDH, followed by the serum to pleural fluid protein (SF-P) and then the serum to pleural fluid albumin (SF-A) gradients, may assist in reclassifying pleural effusions as transudates [47].…”

Section: Diagnostic Clues For Exudates From Transudatesmentioning

confidence: 99%

Role of Pleural Fluid Cholesterol in Pleural Effusion

Hamal¹

2018

Cholesterol - Good, Bad and the Heart

View full text Add to dashboard Cite

Pleural effusion occurs when formation and accumulation of pleural fluid exceeds its absorption. It indicates an imbalance between pleural fluid formation and its removal. Pleural fluid accumulates in settings of increased hydrostatic pressure, increased vascular permeability, decreased oncotic pressure, increased intrapleural negative pressure and decreased lymphatic drainage. On the basis of pathophysiology, pleural effusion can be transudates or exudates. It is important to establish an accurate etiological diagnosis so that the patient may be treated in a rational manner. Using Light's criteria may need other extra investigations to differentiate transudates and exudates but using pleural fluid cholesterol (pCHOL) will help to diagnose them with only the pleural fluid analysis. Moreover the albumin or protein gradient will need serum as well as the pleural fluid investigations and will have more financial burden than just investigating pleural fluid cholesterol. Pleural cholesterol is thought to be derived from degenerating cells and vascular leakage from increased permeability. Thus pleural fluid cholesterol is one of the important investigations that can distinguish exudates from transudates. Routine use of pleural fluid cholesterol for classifying pleural effusion should be encouraged to improve the accuracy, sensitivity and specificity.

show abstract

“…The majority of these errors occur in patients where exudative criteria are barely met and usually in only one of the three elements of Light's criteria [11]. If clinical suspicion exists that the effusion has been misclassified, additional calculations using serum-pleural fluid albumin gradient or serumpleural fluid protein gradient can be helpful [12].…”

Section: Diagnosismentioning

confidence: 99%