New criteria for the differentiation between transudates and exudates

Abstract

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.

Comparative utility of biochemical markers for differential diagnosis of ascites

“…Basaran GS et al and Paramothayan et al had showed that fluid LDH is a better parameter than others to differentiate fluids into transudate and exudate. 3,7 However in the present study, we found that SAAG (accuracy 89.09 %) is the better parameter than fluid LDH (accuracy 85.45%).…”

“…The cut off value of 200U/L was used to differentiate between transudates and exudates. 3,7 In contrast to the concept of transudates and exudates, serum ascitic albumin gradient (SAAG) has been proposed as physiologically based alternative to categorise the fluids in much better way, as SAAG is influenced by only one variable-portal pressure. Poor The present study results demonstrated that the parameter fluid total protein (cut off value 3 gm/dl) had lowest accuracy of 63.63% as compared to other parameters.…”

Diagnostic value of carbohydrate antigens in supernatants and sediments of pleural effusions

“…This distinction was based on classic Light's criteria (1). Since Light criteria permit the classification of some pleural fluid, although not always accurately (2)(3)(4)(5), fluid to serum protein ratio was suggested (5). The main importance of this trasudate/exudate distinction is in determining the need for subsequent diagnostic tests.…”

Profile of children with pleural effusion in an urban tertiary care hospital

“…Statistical comparison of mean pleural fluid levels of protein, Glucose and LDH in tuberculosis, empyema and parapneumonic origin revealed to be significant in pleural fluid Glucose and LDH (<0.05) whereas it was insignificant in protein (>0.05) ( Table 4). (13) 1099.23 553.14 Empyema (9) 4695.49 2370.99 Dengue fever (2) 069.50 06.36…”

“…1 It is important to classify pleural fluids into exudates and transudates because this is indicative of underlying pathophysiological process involved, such a distinction allows appropriate investigations to be instigated enabling better patient management. 2 Light et al has established criteria for demonstrating high degree of age from 1 year to 17 years of age of either sex were included in the study in whom thoracocentesis can yield minimum amount of pleural fluid required for diagnosis and culture, those in whom required fluid could not be aspirated were excluded from the study. Detailed history, general physical, systemic examination and investigations were performed.…”