Pleural fluid MDA and serum-effusion albumin gradient in pleural effusion

Mangaraj, Manaswini; Kumari, Saroj; Nanda, Rachita; Pattnaik, Manoranjan; Mohapatra, Prasanta K.

doi:10.1007/s12291-008-0019-1

Cited by 8 publications

(7 citation statements)

References 13 publications

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“… 10 Also, all 7 patients were on diuretics at the time of presentation, consistent with other reports of patients with hepatic hydrothorax who had elevated pleural fluid protein. 3 , 8 , 10 , 23 , 29 …”

Section: Discussionmentioning

confidence: 99%

“…A transudate was defined as having either a pleural fluid to serum protein ratio of ≤0.50, a pleural fluid to serum lactate dehydrogenase (LDH) ratio of ≤0.6, or a pleural fluid LDH <143 units/L, which is two-thirds of the upper limit of normal for serum LDH (214) at our institutions. 12 , 23 Patients were excluded in the setting of known infection, positive Gram stain, culture, or glucose <65 mg/dL. 4 , 10 , 31 …”

Section: Methodsmentioning

confidence: 99%

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Hepatic Hydrothorax

2014

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Hepatic hydrothorax is an important and difficult-to-manage complication of cirrhosis and portal hypertension. Here, we aimed to study its clinical features and natural history. Complete clinical data, including outcomes, were abstracted from hospital records of patients with cirrhosis and ascites admitted to University of Texas Southwestern University teaching hospitals from January 2001 to July 2012. Hepatic hydrothorax was diagnosed based on currently accepted clinical characteristics of the disease, including a known diagnosis of cirrhosis, the presence of portal hypertension, pleural fluid analysis, and the absence of primary cardiopulmonary disease.Seventy-seven of 495 (16%) hospitalized cirrhotic patients with pleural effusion (28 female; mean age, 52 yr) met the criteria for diagnosis of hepatic hydrothorax. Resting dyspnea and cough were the most prominent presenting symptoms, occurring in 34% and 22% of patients, respectively. Pleural effusions were most often right-sided (56/77; 73%), followed by left-sided only (13/77; 17%) and bilateral effusions (8/77; 10%); 7 (9%) patients did not have detectable ascites. The mean Model for End-Stage Liver Disease (MELD) score at presentation was 16. The serum to pleural fluid albumin gradient (SPAG) was ≥1.1 in all 48 patients in whom it was measured. Most patients (64/77; 83%) were managed with diuretics and/or thoracentesis, while 8 (10%) underwent transjugular intrahepatic portosystemic shunt (TIPS) and 5 (7%) underwent liver transplant. A total of 44 of 77 (57%) patients died during a mean follow-up of 12 months. The average time from presentation to death for all patients was 368 days, while for those after TIPS it was 845 days. No deaths were reported in the liver transplant group. The data indicate that a substantial number of patients with hepatic hydrothorax had what may be considered atypical presentations, including left-sided only effusions, or pleural effusion without ascites. Here, we propose that the term “serum to pleural fluid albumin gradient (SPAG)” be used to describe the gradient between serum and pleural fluid albumin levels and suggest that not only is it consistent with the portal hypertensive pathophysiology of hepatic hydrothorax, but also it is a useful criterion for diagnosis of hepatic hydrothorax. Finally, the overall outcome of hepatic hydrothorax was extremely poor, except in those undergoing TIPS or liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Hepatic Hydrothorax

2014

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“…Biochemical parameters of pleural fluid were determined using a selective discrete multichannel analyzer. Total protein concentration (g/dl) was measured by auto analyzer using Biuret method (Technicon RA 1000),[ 3 ] lactate dehydrogenase (LDH) level were measured by auto analyzer using modified International Federation of Clinical Chemistry (IFCC) method (Technicon RA1000)[ 3 ] and ADA levels measured by auto analyzer using the colorimetric end point method described by Guisti and Galanti[ 4 ] (Microlab 300, Merck, The Netherlands). Then after obtaining proper informed consent pleural biopsy was done in all patients using Abram’s pleural biopsy needle.…”

Section: Methodsmentioning

confidence: 99%

Role of sputum examination for acid fast bacilli in tuberculous pleural effusion

et al. 2011

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Background:Sputum for acid fast bacilli (AFB) is seldom looked for in the etiological diagnosis of tuberculous pleural effusion usually due to the absence of any parenchymal lesion radiologically, but presence of tubercle bacilli in sputum may have important epidemiological and therapeutic implication.Aims:This study aims to evaluate the role of sputum examination for AFB in the patients of tuberculous pleural effusion with no apparent lung parenchymal lesion radiologically.Settings and Design:Forty-five consecutive indoor patients of suspected tuberculous pleural effusion having no apparent lung parenchymal lesion on chest radiography were selected for our study. It was a prospective and observational study conducted over a period of 1 year.Materials and Methods:After confirming the etiology of pleural effusion as tuberculous by biochemical, cytological, histopahtological, and microbiological tests, emphasis was given on sputum examination for AFB by smear examination and culture for Mycobacterium tuberculosis.Results:Sputum was bacteriologically (smear and /or culture) positive for tuberculosis in 10 out of 30 cases (33.33%) in which tuberculous etiology was confirmed by histology and /or bacteriology (definite tuberculosis). No sputum AFB (smear and culture) was found in 15 cases of probable tuberculosis where tuberculous etiology was established by indirect methods like Adenosine de aminase level more than 40 unit/l and other relevant investigations. Over all, sputum was bacteriologically smear and/or culture positive in 10 out of 45 cases (22.22%).Conclusion:Careful and thorough sputum examination in cases of tuberculous pleural effusion may help as a diagnostic tool and it has therapeutic and epidemiological implications.

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“…Total protein concentration (g/dl) was measured by auto analyzer using Biuret method (Technicon RA 1000). [ 2 ], Lactate dehydrogenase (LDH) levels were measured by auto analyzer using modified IFCC (International federation of clinical chemistry) method (Technicon RA 1000)[ 2 ] and ADA level measured by auto analyzer using the colorimetric end point method described by Guisti and Galanti[ 3 ] (Microlab300, Merck, Netherland). Light’s criteria were used to distinguish exudates from trasudates.…”

Section: Methodsmentioning

confidence: 99%

Role of pleural biopsy in etiological diagnosis of pleural effusion

et al. 2010

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Background:Pleural effusion remains the most common manifestation of pleural pathology. Sometimes it is difficult to differentiate between tubercular and malignant pleural effusion in spite of routine biochemical and cytological examination of pleural fluid.Aims:This study aims to evaluate the role of pleural biopsy to determine the etiology of pleural effusion and to correlate it with the biochemical and cytological parameters of pleural fluid.Settings and Design:Seventy two consecutive patients of pleural effusion were selected from the out patient and indoor department of a tertiary hospital of Kolkata. It was a prospective and observational study conducted over a period of one year.Materials and Methods:Biochemical, cytological and microbiological evaluation of pleural fluid was done in all cases. Those with exudative pleural effusions underwent pleural biopsy by Abram’s needle. Subsequently, the etiology of effusion was determined.Results:Malignancy was the most common etiology, followed by tuberculosis. Pleural biopsy was done in 72 patients. Pleural tissue was obtained in 62 cases. Malignancy was diagnosed in 24, tuberculosis in 20 and non-specific inflammation in 18, on histopathological examination. Out of 20 histological proven tuberculosis cases adenosine de-aminase (ADA) was more than 70 u/l in 11 cases.Conclusions:In our study, malignancy is more common than tuberculosis, particularly in elderly. When thoracoscope is not available, pleural fluid cytology and pleural biopsy can give definite diagnosis. Pleural fluid ADA ≥ 70 u/l is almost diagnostic of tuberculosis, where pleural biopsy is not recommended.

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Pleural fluid MDA and serum-effusion albumin gradient in pleural effusion

Cited by 8 publications

References 13 publications

Hepatic Hydrothorax

Hepatic Hydrothorax

Role of sputum examination for acid fast bacilli in tuberculous pleural effusion

Role of pleural biopsy in etiological diagnosis of pleural effusion

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