ROLE OF PLEURAL FLUID CHOLESTEROL IN DIFFERENTIATING TRANSUDATIVE AND EXUDATIVE PLEURAL EFFUSION
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 7
Abstract
BACKGROUND Pleural effusion is defined as an abnormal and excessive collection of fluid in the pleural space. The most common cause in the West and India are infections followed by malignancy. In India, tubercular effusion is the most common cause followed by malignant effusion and a very few due to parapneumonic effusion. Aims and Objectives- To study the role of pleural fluid cholesterol in differentiating transudative and exudative pleural effusion and comparison of pleural fluid cholesterol to Light’s criteria. MATERIALS AND METHODS In this prospective study, 204 patients with pleural effusion were included. Pleural fluid cholesterol, total protein, lactate dehydrogenase (LDH) as well as serum total protein and LDH levels along with other required investigations were studied. Clinical classification of transudative or exudative was done on the basis of aetiology. RESULTS Based on pleural fluid examination for cholesterol, protein, LDH and other haematological investigations and response to treatment besides history, clinical examination finding and chest radiograph, 173 patients were classified as exudates and 31 as transudates. Using pleural fluid cholesterol levels at a cut-off point of greater than 45 mg/dL for distinguishing transudates and exudates the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 98%, 100%, 98% and 100% respectively. In the present study when pleural fluid cholesterol cut-off was taken as 60 mg/dL it was found that the sensitivity of differentiating exudates was 82%, while specificity was found to be 100% with PPV of 100% and NPV of 44%. Using Light’s criteria for discriminating transudates and exudates, sensitivity, specificity, PPV and NPV were found to be 98%, 100%, 100% and 92% respectively. In the present study, pleural fluid protein > 3 gm/dL when used as a differentiating parameter for transudates and exudates had a sensitivity of 98%, specificity and PPV of 100% and NPV of 74% respectively. CONCLUSION Pleural fluid cholesterol is cost-effective and useful parameters in distinguishing transudative from exudative aetiologies with the advantage of requiring only one laboratory determinations and no simultaneous blood sample compared to the use of Light’s criteria.
Authors and Affiliations
Tariq Mahmood, Kaleem Ahmad, Arvind Kumar Verma, Shukla A. D, Abhinav C, Srinivasa Srinivasa
Keywords
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- EP ID EP399103
- DOI 10.14260/jemds/2018/207
- Views 88
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