Is it Meaningful to use Biochemical Parameters to Discriminate Between Transudative and Exudative Pleural Effusions?

Romero-Candeira, Santiago; Hernández, Luís; Romero-Brufao, Susana; Orts, David; Fernández, Cleofé; Martín, César Casquet

doi:10.1378/chest.122.5.1524

Cited by 98 publications

(65 citation statements)

References 18 publications

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“…(10) By applying the classical criterion to the study sample, we were able to classify the two types of plural effusion correctly, and the parameters obtained support the use of the criterion in Brazil. However, in order to do so, it is necessary to collect blood and pleural fluid samples simultaneously.…”

Section: Discussionmentioning

confidence: 60%

Dosagem de proteínas totais e desidrogenase lática para o diagnóstico de transudatos e exsudatos pleurais: redefinindo o critério clássico com uma nova abordagem estatística

et al. 2010

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Objective: To propose a new classification criterion for the differentiation between pleural exudates and transudates-quantifying total proteins in pleural fluid (TP-PF) and lactate dehydrogenase in pleural fluid (LDH-PF) exclusively-as well as to compare this new criterion with the classical criterion in terms of diagnostic yield. Methods: This was an observational, cross-sectional study with a within-subject design, comprising 181 patients with pleural effusion treated at two university hospitals in the state of Rio de Janeiro, Brazil, between 2003 and. The diagnostic parameters included in the classical criterion were identified, as were those included in the new criterion. Results: Of the 181 patients, 152 and 29 were diagnosed with pleural exudates and pleural transudates, respectively. For the classical criterion, the sensitivity, specificity, and accuracy for the diagnosis of pleural exudates were, respectively, 99.8%, 68.6%, and 94.5%, whereas the corresponding values for the diagnosis of pleural transudates were 76.1%, 90.1%, and 87.6%. For the new criterion (cut-off points set at 3.4 g/dL for TP-PF and 328.0 U/L for LDH-PF), the sensitivity, specificity, and accuracy for the diagnosis of exudates were, respectively, 99.4%, 72.6%, and 99.2%, whereas the corresponding values for the diagnosis of transudates were 98.5%, 83.4%, and 90.0%. The accuracy of the new criterion for the diagnosis of pleural exudates was significantly greater than was that of the classical criterion (p = 0.0022). Conclusions: The diagnostic yield was comparable between the two criteria studied. Therefore, the new classification criterion can be used in daily practice. Keywords:Pleural effusion/diagnosis; Pleural effusion/classification; Exudates and transudates. ResumoObjetivo: Propor um novo critério de classificação para a diferenciação entre exsudatos e transudatos pleurais através da dosagem de proteínas totais no líquido pleural (PT-LP) e de desidrogenase lática no líquido pleural (DHL-LP) exclusivamente, assim como comparar o rendimento diagnóstico entre esse novo critério com o critério clássico. Métodos: Estudo observacional, transversal de tipo individualizado, no qual foram selecionados 181 pacientes com derrame pleural tratados em dois hospitais universitários no estado do Rio de Janeiro (RJ) entre 2003 e 2006. Os parâmetros diagnósticos incluídos no critério clássico, assim como os do novo critério, foram determinados. Resultados: Dos 181 pacientes, 152 e 29 foram diagnosticados, respectivamente, com exsudato pleural e transudato pleural. A sensibilidade, especificidade e acurácia do critério clássico para o diagnóstico de exsudato pleural foram, respectivamente, de 99,8%, 68,6% e 94,5%, enquanto, para o diagnóstico de transudato pleural, essas foram de 76,1%, 90,1% e 87,6%. Utilizando-se os pontos de corte de 3,4 g/dL para a dosagem de PT-LP e de 328,0 U/L para aquela de DHL-LP (novo critério), a sensibilidade, especificidade e acurácia foram de, respectivamente, 99,4%, 72,6% e 99,2%, para o diagnóstico de exs...

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Section: Discussionmentioning

confidence: 60%

Dosagem de proteínas totais e desidrogenase lática para o diagnóstico de transudatos e exsudatos pleurais: redefinindo o critério clássico com uma nova abordagem estatística

et al. 2010

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“…Diuretics may change a transudate into an exudate by shifting fluid from the pleural space, which may elevate the levels of protein and LDH in the pleural fluid. [2][3][4]21 Pleural fluid NT-proBNP is suggested to be useful in the diagnosis of pleural effusion resulting from heart failure, especially in patients with exudates who are treated with diuretics. Han et al 2 reported that 26 of the 28 misclassified heart-failure patients received diuretics before thoracentesis and had pleural fluid NT-proBNP levels of higher than 1,714 pg/mL.…”

Section: Discussionmentioning

confidence: 99%

“…1 However, these criteria have some limitations, especially in patients with heart failure and taking diuretics. 2,3 Imbalance of hydrostatic and osmotic forces caused by heart failure is the main reason that transudates and diuretic therapy limit the accuracy of the criteria, leading to misdiagnosis of pleural fluids. 4,5 Misdiagnosis of transudates as exudates may lead to unwarranted invasive interventions or delay in the ini-tiation of appropriate therapy.…”

Section: Introductionmentioning

confidence: 99%

“…Although clinical judgment can aid in determining which patients with pleural effusion most likely have heart failure, the criteria of Light et al 1 are shown to be significantly superior to clinical presumption to separate heart-failure-associated transudates from exudates. 3 Thus, several other methods have been proposed to differentiate exudates from transudates, including the serum-effusion albumin difference (a difference of Ͻ 1.2 g/dL between the serum and pleural fluid albumin levels), 6 serum-effusion protein difference, pleural cholesterol concentration (pleural cholesterol Ͼ 60 mg/dL), 7 and pleural effusion/serum bilirubin ratio (a pleural fluid/ serum bilirubin ratio Ͼ 0.6). 8 However, controversy exists as to which method is more accurate and effective.…”

Section: Introductionmentioning

confidence: 99%

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Pleural Fluid Amino-Terminal Brain Natriuretic Peptide in Patients With Pleural Effusions

et al. 2013

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BACKGROUND: Definite diagnosis of transudative or exudative pleural fluids often presents a diagnostic dilemma. The aim of this study was to evaluate whether amino-terminal brain natriuretic peptide (NT-proBNP) levels in pleural fluid has a diagnostic value for discriminating heart-failurerelated pleural effusions from non-heart-failure effusions. METHODS: Sixty-six subjects (40 male, mean age 61 ؎ 18 y) with pleural effusions were included. Samples of pleural fluid and serum were obtained simultaneously from each subject. Biochemical analysis, bacterial and fungal culture, acid-fast bacilli smear and culture, and cytology were performed on the pleural fluid. RESULTS: Subjects with heart-failure-related pleural effusion had significantly higher pleural NT-proBNP levels than other subjects (P < .001). Pleural and serum NT-proBNP measures were closely correlated (r ‫؍‬ 0.90, P < .001). An NT-proBNP cutoff value of > 2,300 pg/mL in pleural fluid had a sensitivity of 70.8%, a specificity of 97.6%, and positive and negative predictive values of 94.4% and 85.4%, respectively, for discriminating transudates caused by heart failure from exudates. Eight heart-failure subjects were misclassified as exudates by Light's criteria, 5 of whom received diuretics before thoracentesis. All misclassified subjects had pleural NT-proBNP levels higher than 1,165 pg/mL, which predicted heart-failure-associated transudates with 95.8% sensitivity and 85.7% specificity. CONCLUSIONS: Pleural fluid NT-proBNP measurement in the routine diagnostic panel may be useful in differentiation of heart-failure-related pleural effusions and exudative pleural fluids with reasonable accuracy, especially in heart-failure patients treated with diuretics.

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“…However, transudate and exudate classification of pleural effusions with Light's criteria can occasionally fail, especially in cases that have undergone diuresis (2,3). If the pleural effusion is definitely identified as a transudate, no further diagnostic procedures are needed (1,4). If it is found to be an exudate, additional diagnostic procedures such as pleural fluid cytopathology, Gram staining, culture, etc.…”

mentioning

confidence: 99%

Can diffusion weighted MRI differentiate between inflammatory-infectious and malignant pleural effusions?

Karatağ¹,

Alar²,

Koşar³

et al. 2015

Journal of the Belgian Society of Radiology

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Is it Meaningful to use Biochemical Parameters to Discriminate Between Transudative and Exudative Pleural Effusions?

Cited by 98 publications

References 18 publications

Dosagem de proteínas totais e desidrogenase lática para o diagnóstico de transudatos e exsudatos pleurais: redefinindo o critério clássico com uma nova abordagem estatística

Dosagem de proteínas totais e desidrogenase lática para o diagnóstico de transudatos e exsudatos pleurais: redefinindo o critério clássico com uma nova abordagem estatística

Pleural Fluid Amino-Terminal Brain Natriuretic Peptide in Patients With Pleural Effusions

Can diffusion weighted MRI differentiate between inflammatory-infectious and malignant pleural effusions?

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