Measurement of Pleural Fluid Cholesterol and Lactate Dehydrogenase

Costa, Marina; Quiroga, Teresa; Cruz, Edgardo

doi:10.1378/chest.108.5.1260

Cited by 58 publications

(12 citation statements)

References 8 publications

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“…However, the recently proposed combination of LDH and cholesterol in PF has a discriminative capacity that may be considered equivalent to that of Light’s criteria. Because this equivalent accuracy has been repeatedly found [8, 9, 10], the decision of changing to this last option may be considered justified based on the cost saving of the determination of PF protein concentrations as well as the simultaneous collection and processing of a serum sample. Moreover, the routine determination of cholesterol in PF may be useful in the identification of some lipid effusions.…”

Section: Discussionmentioning

confidence: 99%

“…However, using those criteria, 10–30% of all transudates will be considered exudates, a shortcoming which is not even solved with the alternative use of the criteria proposed by Costa et al [8]. Patients in whom a false diagnosis of exudate is done may be subjected to a blind pleural biopsy, followed by pleuroscopy and thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, almost simultaneously, a different group of investigators has found an accuracy of 99% combining the determination of pleural LDH and cholesterol concentrations [8]. …”

Section: Introductionmentioning

confidence: 99%

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Light’s Criteria Revisited: Consistency and Comparison with New Proposed Alternative Criteria for Separating Pleural Transudates from Exudates

et al. 2000

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Objectives: The first objective was to assess the diagnostic value of new biochemical criteria proposed to discriminate pleural transudates from exudates and to compare their efficiency with those of Light’s criteria. The second objective of the study was to assess the interstudy variability of the parameters repeatedly determinated in two different groups of patients with pleural effusion. Patients and Methods: We recorded clinical characteristics and final diagnoses and measured pleural fluid (PF) and serum levels of protein, LDH, cholesterol and cholinesterase of 243 patients with pleural effusion. Results: Sixty-one (25%) pleural effusions were transudates and 182 were exudates. The sensitivity (99%) and accuracy (96%) of Light’s criteria were higher than those of the other criteria tested, although the differences with those of the PF LDH-cholesterol combination (96 and 93%) did not show statistical significance. Pleural LDH concentration was the criterion with the highest specificity (95%), being significantly higher (p < 0.05) than that of Light’s criteria. The sensitivity, specificity and accuracy of most criteria tested did not vary when compared with those obtained in a study performed 5 years previously. Conclusions: Light’s criteria remain the criteria of choice for segregating exudates from transudates. Based on cost-efficiency reasons, the PF LDH-cholesterol combination appears as an alternative. Because both sets of criteria misdiagnose a substantial percentage of transudates, exceptions based on good clinical judgment and the complementary use of a more specific criterion, as the PF concentration of LDH, must be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Light’s Criteria Revisited: Consistency and Comparison with New Proposed Alternative Criteria for Separating Pleural Transudates from Exudates

et al. 2000

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“…To determine the usefulness of combined biochemical parameters for identification of exudates, we first compared the diagnostic accuracy of several combinations of criteria that were previously published: (1) Light’s criteria [1] (pleural fluid to serum LDH ratio greater than 0.6 or pleural fluid LDH greater than two thirds the upper limit of normal serum LDH or pleural fluid to serum protein ratio greater than 0.5); (2) modified Light’s criteria as suggested by a previous publication [18]: Light’s criteria or pleural cholesterol greater than 1.42 mmol/L (55 mg/dL); and (3) Costa’s criteria [9]: pleural fluid LDH greater than 200 U/L or pleural fluid cholesterol greater than 1.42 mmol/L (55 mg/dL). The upper normal limit for serum LDH was 225 U/L in the main cohort and 200 U/L in the validation cohort.…”

Section: Methodsmentioning

confidence: 99%

“…A recent meta-analysis supports the clinical importance of pleural cholesterol as a useful clinical marker to help rule in or rule out the presence of an exudate [8]. A previous study by Costa et al [9] involving 188 highly selected patients proposed the use of pleural cholesterol greater than 45 mg/dL or pleural lactate dehydrogenase (LDH) greater than 200 U/L to differentiate exudates from transudates with a sensitivity of 99% and a specificity of 98%. These promising results have not been replicated and have not become usual practice [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Simplified Criteria Using Pleural Fluid Cholesterol and Lactate Dehydrogenase to Distinguish between Exudative and Transudative Pleural Effusions

et al. 2019

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Background: An important part of the investigation of pleural effusion is the identification of markers that help separate exudate from transudate. Objectives: The purposes of this study were to compare the accuracy of published and new sets of criteria to distinguish between exudative and transudative pleural effusions, and to determine whether serum biochemical analysis is necessary. Methods: An externally validated cohort study was performed. Pleural effusions were determined to be transudative or exudative on the basis of an assessment of the medical record by two clinicians blinded to biochemical results. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating characteristic curve were determined for each proposed combination of criteria. Results: Pleural fluid analysis was available for 311 thoracenteses in the main cohort and for 112 thoracenteses in the validation cohort. The best sensitivity (97% [95% CI 94–99]) and negative likelihood ratio (0.04 [95% CI 0.02–0.08]) for identifying exudative effusions were observed with criteria combining pleural fluid lactate dehydrogenase greater than 0.6 the upper limit of normal serum lactate dehydrogenase and pleural fluid cholesterol greater than 1.04 mmol/L (40 mg/dL). The overall diagnostic accuracy was similar to Light’s criteria. Findings were similar in the validation cohort. Conclusions: Our proposed criteria using simultaneously pleural fluid lactate dehydrogenase and pleural fluid cholesterol can identify an exudate with a sensitivity and an overall diagnostic accuracy similar to Light’s criteria. It avoids simultaneous blood sampling, thus reducing patient discomfort and potential costs.

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