Combined pleural fluid cholesterol and total protein in differentiation of exudates and transudates.
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Date
2013-01
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Abstract
Background. The management strategy to be adopted in pleural effusion depends on whether an effusion is a transudate
or exudate.
Objective. To evaluate the usefulness of pleural fluid cholesterol and/or total protein measurements for differentiating
between exudates and transudates, and to compare it with Light’s criteria.
Methods. In this prospective study 60 patients with pleural effusion were included. Pleural fluid total protein, lactate
dehydrogenase (LDH) and cholesterol as well as serum total protein and LDH levels along with other investigations were
studied. Clinical classification of transudate or exudate was done on the basis of aetiology.
Results. Based on clinical signs and symptoms, chest radiograph, other investigations and response to treatment, 49 of these
effusions were classified as exudates and 11 as transudates. Using pleural fluid cholesterol levels at a cut-off point of greater
than 60 mg/dL and/or total protein at a cut-off point of greater than 3 g/dL for distinguishing transudates and exudates,
the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), were 100 percent. Using
Light’s criteria for discriminating transudates and exudates, sensitivity, specificity, PPV and NPV were found to be 98%;
100%; 100% and 92%, respectively. The differences resulted from a mis-classification of one expected exudate as transudate
by Light’s criteria.
Conclusion. Pleural fluid cholesterol and total protein are simple, cost-effective, and useful parameters in distinguishing
pleural transudates from exudates, with the advantage of requiring only two laboratory determinations and no
simultaneous blood sample, compared to the use of Light’s criteria.
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Keywords
Pleural fluid total protein, Cholesterol, Light's criteria, Transudates, Exudates
Citation
Patel Anand K, Choudhury Sushmita. Combined pleural fluid cholesterol and total protein in differentiation of exudates and transudates. The Indian Journal of Chest Diseases and Allied Sciences, 2013 Jan; 55(1): 21-24.