CLINICAL VERSUS LIGHT’S CRITERIA VERSUS SERUM PLEURAL FLUID ALBUMIN GRADIENT IN DIFFERENTIATING BETWEEN TRANSUDATIVE AND EXUDATIVE PLEURAL EFFUSIONS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 45
Abstract
BACKGROUND The first and important step is to classify pleural effusion into transudates and exudates. Traditionally, Light’s criteria are used to separate transudative from exudative pleural effusions. Light’s criteria misidentify about 20% of transudates as exudates, particularly in patients with heart failure on diuretics. In such cases serum pleural fluid albumin gradient is used to correctly identify transudates. Apart from Light’s criteria, the nature of the effusion can also be assessed by clinical examination. Very few studies have been done to evaluate the efficacy of clinical judgement with respect to Light’s criteria in determining the transudative or exudative nature of the pleural effusion.1,2 Few studies have been done to evaluate the efficacy of Light’s criteria and serum pleural fluid albumin in determining transudative and exudative pleural effusions.3,4 But no studies were done to evaluate the efficacy of clinical judgement, Light’s criteria and serum pleural fluid albumin gradient in differentiating transudative and exudative pleural effusions. MATERIALS AND METHODS The observational, descriptive, cross-sectional study was conducted on 60 patients coming to the outpatient department as well as those admitted to the wards in Department of Pulmonary Medicine, Maharajah Institute of Medical Sciences during the period November 2013 to October 2015 with evidence of pleural effusion. Pleural fluid analysis is done to differentiate between transudative and exudative effusions, additionally Light’s criteria and serum pleural fluid albumin gradient is used for all samples. RESULTS Of the 60 patients, 50 were males and 10 were females. The age of the patients ranged between 15 - 85 years. Of the 60 effusions, 20 (33.3%) are transudates and 40 (66.6%) are exudates. Among the transudates CHF was the commonest disease and among exudates tuberculosis was the leading disease followed by synpneumonic effusion. Transudates were common in older age group, whereas exudates were common in younger and middle age group. Of 20 transudative effusions, clinical presumption could rightly classify all of them as transudates. Light’s criteria could classify only 12 of them as transudates and it misclassified 8 cases, of which (6 cases of CHF, 1 case of CKD, 1 case of Cirrhosis) on diuretic as exudates. SAPA could rightly classify all of them as transudates. Out of the 40 exudative effusions, clinical presumption could rightly classify 39 effusions, but misclassified 1 case of CHF as transudate. Light’s criteria could rightly classify all the 40 exudative effusions as exudates. SAPA could rightly classify 39 effusions, but misclassified 1 case of synpneumonic effusion as transudate. CONCLUSION The present study shows that the clinical criteria and SAPA are superior to Light’s criteria in identifying the transudative effusions (100% vs 60% vs 100%). Light’s criteria identified exudative effusions better than clinical criteria and SAPA (100% vs 97.5% vs 97.5%). So, in primary health centres where biochemical analysis is not available, clinical criteria can be used to separate transudates and exudates.
Authors and Affiliations
Pandu Viritha, Ramya Gadam, V. Venkata Ramana Reddy
Keywords
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- EP ID EP549282
- DOI 10.14260/jemds/2018/1088
- Views 127
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