Pleural Fluid Analysis: Standstill or a Work in Progress?

Hassan, Tidi; Al‐Alawi, Mazen; Chotirmall, Sanjay H.; McElvaney, Noel G.

doi:10.1155/2012/716235

Cited by 16 publications

(18 citation statements)

References 70 publications

(70 reference statements)

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“…6 High levels of ADA have also been reported in many other conditions including malignant effusion, rheumatoid arthritis, systemic lupus erythematosis, empyema and fungal infections. 1 In the present study two empyema cases of non tubercular origin showed very high values of ADA.…”

Section: Discussionsupporting

confidence: 57%

“…Accumulation of pleural fluid may be due to various causes such as increased pleural membrane permeability, increased capillary pressure, decreased oncotic pressure and lymphatic obstruction. 1 Transudative pleural effusions occur when systemic factors which effect the formation and absorption of pleural fluid are altered. Exudative pleural effusion occur secondary to local diseases.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of Pleural Fluid Adenosine Deaminase and C-Reactive Protein Levels in Early Differential Diagnosis of Pleural Effusion.

Nusrath¹,

M²,

Rajeshwari³

et al. 2013

jemds

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-CONTEXT: Pleural effusion occurs secondary to various diseases. Common causes of exudative effusion are tuberculosis, bacterial pneumonia, and malignancy. Transudative effusion is due to systemic diseases like cardiac failure, cirrhosis of liver. Conventional methods of diagnosis may not be able to establish the cause of pleural effusion. Early diagnosis and management reduces the morbidity and mortality.AIM: The objective of the study is to estimate pleural fluid Adenosine Deaminase (ADA) and C -reactive protein (CRP) levels and to evaluate their efficacy in differential diagnosis of transudative and exudative, tuberculous and non tuberculous and inflammatory and non inflammatory effusions. MATERIAL AND METHODS: Fifty two patients of pleural effusion were investigated and divided into four groups based on diagnosis. Group I, II, III and IV had 24 cases of tuberculous effusion, 13 cases of transudative effusion, 08 cases of malignant effusion and 07 cases of parapneumonic effusion respectively. Pleural fluid was analyzed for ADA (Guisti and Galanti's method) and CRP (turbidometric immunoassay).STATISTICAL ANALYSIS: The statistical analysis was done using unpaired student't' test and p value < 0.05 was considered statistically significant. RESULTS: In the present study pleural fluid ADA revealed highly significant increase in tuberculous effusion than non tuberculous effusions (p <0.001) and also when compared with non tuberculous subgroups, transudative effusion (p < 0.001), malignant effusion (p<0.001), and PPE (p<0.01). ADA levels at a cutoff value of 40U/L, showed sensitivity, specificity, positive predictive value and negative predictive value of 91.67%, 89.3%, 88% & 92.6% respectively in tuberculous effusion. Pleural fluid CRP levels in parapneumonic effusion were significantly higher compared to other types of effusions (p<0.001). Significantly higher levels of CRP were seen in exudative effusion compared to transudative effusion (p<0.001) and in inflammatory effusion compared to non inflammatory effusion (p<0.001). ORIGINAL ARTICLEJournal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 22/ June 3, 2013Page 3988 CONCLUSIONS: Pleural fluid ADA is sensitive test in discriminating tuberculous and non tuberculous effusions. Pleural fluid CRP levels distinguish transudative from exudative effusion, inflammatory from non inflammatory effusion. ADA and CRP assays are rapid, minimally invasive and cost effective and measurement of these two parameters increases the efficacy of diagnosing pleural effusion. KEY WORDS: Adenosine deaminase, C -reactive protein, Pleural effusion. INTRODUCTION:Pleural effusion (PE) is a common complication associated with number of diseases. Accumulation of pleural fluid may be due to various causes such as increased pleural membrane permeability, increased capillary pressure, decreased oncotic pressure and lymphatic obstruction. 1 Transudative pleural effusions occur when systemic factors which effect the formation and absorption of pleural fluid are altered. Ex...

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Efficacy of Pleural Fluid Adenosine Deaminase and C-Reactive Protein Levels in Early Differential Diagnosis of Pleural Effusion.

Nusrath¹,

M²,

Rajeshwari³

et al. 2013

jemds

View full text Add to dashboard Cite

show abstract

“…Various tests can be performed for pleural fluid (PF) analysis, either as sole or additional diagnostic tools to further determine the effusion’s etiology (4,5). …”

Section: Pleural Effusionsmentioning

confidence: 99%

Pleural, peritoneal and pericardial effusions – a biochemical approach

Kopcinovic

Culej

2014

Biochem Med

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The pathological accumulation of serous fluids in the pleural, peritoneal and pericardial space occurs in a variety of conditions. Since patient management depends on right and timely diagnosis, biochemical analysis of extravascular body fluids is considered a valuable tool in the patient management process.The biochemical evaluation of serous fluids includes the determination of gross appearance, differentiation of transudative from exudative effusions and additional specific biochemical testing to assess the effusion etiology. This article summarized data from the most relevant literature concerning practice with special emphasis on usefulness of biochemical tests used for the investigation of pleural, peritoneal and pericardial effusions. Additionally, preanalytical issues concerning serous fluid analysis were addressed and recommendations concerning acceptable analytical practice in serous fluid analysis were presented.

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“…Increased levels of NT-proBNP have been positively correlated with congestive heart failure as a cause of the PE (Porcel and Light 2006;Porcel 2013). Furthermore, CRP levels have been reported to be higher in parapneumonic PEs (Hassan et al 2012;Zou et al 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, CRP levels have been reported to be higher in parapneumonic PEs (Hassan et al. ; Zou et al. ).…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta‐analysis of vascular endothelial growth factor as a biomarker for malignant pleural effusions

Fafliora

Hatzoglou

Gourgoulianis

et al. 2016

Physiological Reports

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Conventional methods may fail to identify the cause of pleural effusion (PE), thus establishing reliable biomarkers is deemed necessary. This study aimed at examining the role of vascular endothelial growth factor (VEGF) as a biomarker in the differentiation between malignant and benign PEs in adults. A comprehensive literature search in PubMed (Medline), Scopus (ELSEVIER), and Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted using keywords. We included studies that evaluated pleural and/or serum levels of VEGF among patients presenting with undiagnosed PE and the association between these levels and the final diagnosis. We performed a meta‐analysis to calculate the summary effect using the random effects model. Statistical analysis was performed with the statistical package for meta‐analysis Comprehensive Meta‐Analysis. Twenty studies were included in the systematic review, while 11 of them in the meta‐analysis. Pleural fluid VEGF levels among patients with malignant PE were increased by 1.93 ng/mL as compared to patients with benign PE (95% CI: 1.32–2.54, Q = 173, df (Q): 10, I 2 = 94.2%, P < 0.05). Serum VEGF levels among patients with malignant PE were increased respectively by 1.90 ng/mL (95% CI: 0.93–2.88, Q = 182, df (Q): 6, I 2 = 96.7%, P < 0.05). This study showed that malignant PEs were associated with higher levels of both pleural fluid and serum VEGF. VEGF appears to represent a promising biomarker for the differential diagnosis between benign and malignant PEs.

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Pleural Fluid Analysis: Standstill or a Work in Progress?

Cited by 16 publications

References 70 publications

Efficacy of Pleural Fluid Adenosine Deaminase and C-Reactive Protein Levels in Early Differential Diagnosis of Pleural Effusion.

Efficacy of Pleural Fluid Adenosine Deaminase and C-Reactive Protein Levels in Early Differential Diagnosis of Pleural Effusion.

Pleural, peritoneal and pericardial effusions – a biochemical approach

Systematic review and meta‐analysis of vascular endothelial growth factor as a biomarker for malignant pleural effusions

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