Pleural Cholesterol in Differentiating Transudates and Exudates

Suay, V. Gil; Moragón, Eva Martínez; Viedma, Enrique Cases; Tordera, Miguel Perpiñá; Fábregas, M. León; Aldás, Joaquín

doi:10.1159/000196392

Cited by 32 publications

(5 citation statements)

References 11 publications

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“…The cause of the elevated concentration of CHOL in pleural exudates is not clear. Various possible explanations have been reported [11, 13, 19]. The hypothesis that the increase in pleural CHOL in exudates may result from a greater capillary permeability since there is a correlation between pleural CHOL and serum CHOL seems to be more likely.…”

Section: Discussionmentioning

confidence: 99%

“…This method may correctly classify up to 99% of pleural effusions as exudates or transudates. However, other authors found poorer diagnostic results when applying these criteria [9, 10, 11]. Several tumor markers and biochemical parameters have been proposed in an effort to improve the differential diagnosis of pleural effusion [12, 13, 14, 15, 16].…”

Section: Introductionmentioning

confidence: 99%

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Pleural Interleukin-1β in Differentiating Transudates and Exudates: Comparative Analysis with Other Biochemical Parameters

Alexandrakis

Kyriakou²,

Alexandraki³

et al. 2002

Respiration

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Background: The differential diagnosis of pleural effusion is a frequent clinical problem. The possible role of pleural fluid cytokines in discriminating transudates from exudates has not been studied adequately. Objective: The aim of this study was to evaluate the serum and pleural fluid levels of interleukin-1β (IL-1β) and to compare it with common biochemical parameters such as cholesterol (CHOL), lactate dehydrogenase (LDH), total protein and albumin. Methods: One hundred and six consecutive patients with pleural effusion were studied. IL-1β was measured simultaneously in blood and pleural fluid using a radioimmunoassay. Standard laboratory methods were employed for biochemical parameters. Results: Using ROC analysis, a pleural IL-1β cutoff level 18.16 fmol/ml had a sensitivity of 76.8%, a specificity of 58.3% and a positive predictive value (PPV) 86.3% in the discrimination of transudates vs. all exudates. Serum IL-1β levels were higher in the nonmalignant group but without statistical difference compared with transudate patients. In addition, a significant difference was found between serum IL-1β in the malignant group in comparison with those of the transudate group (p < 0.01), also IL-1β levels were significantly increased in exudate effusion when compared with transudate (p < 0.001, p < 0.05, respectively). CHOL values of ≧65 mg/dl had 92.7% sensitivity, and 100% specificity and PPV for both. Conclusions: The results of this study suggest that although IL-1β could be a marker with relatively good sensitivity and PPV for the differentiation of pleural effusion, the cost and time needed do not support its use as a routine laboratory test.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pleural Interleukin-1β in Differentiating Transudates and Exudates: Comparative Analysis with Other Biochemical Parameters

Alexandrakis

Kyriakou²,

Alexandraki³

et al. 2002

Respiration

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“…Pleural fluid develops in the pleural space through different mechanisms [1, 2, 3, 4]. An important step of its evaluation is the distinction between transudates and exudates.…”

Section: Discussionmentioning

confidence: 99%

“…Exudative pleural effusions are the consequence of local inflammation which affects the permeability of pleural surfaces or the lymphatic drainage in the location where the fluid originates [1, 2]. Pleural transudates are due to diseases modifying the plasma colloid-osmotic pressure in pleural capillaries, or to several systemic factors affecting the hydrostatic pressure and alter the mechanism of formation or absorption of pleural fluid [1, 2, 3]; pleural fluid may even be formed by the passage of peritoneal fluid into the pleural space [4]. The criteria proposed by Light et al [5]discriminate pleural exudates on the basis of a pleural fluid to serum protein ratio >0.5 and/or a pleural to serum lactate dehydrogenase (LDH) ratio >0.6.…”

Section: Introductionmentioning

confidence: 99%

Significance of Alpha-2-Macroglobulin, Alpha-1-Acid Glycoprotein, and C-Reactive Protein in Pleural Effusion Differentiation

Alexandrakis¹,

Coulocheri²,

Bouros³

et al. 2000

Respiration

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Background: The differentiation between exudates and transudates is fundamental when investigating the cause of pleural effusions. Acute-phase proteins could be potentially useful markers in this discrimination. Objective: The present study was designed to evaluate whether the acute-phase proteins: α₂-macroglobulin (AMG), α₁-acid glycoprotein (AAG) and C-reactive protein (CRP) are useful in investigating the pleural effusions. Methods: We prospectively measured the concentrations of the above proteins in the serum and pleural fluid of 84 consecutive patients with various diseases using a nephelometric assay. Results: Pleural effusion AMG, AAG and CRP were all significantly elevated in the group of patients with exudates compared to patients with transudates (p < 0.001, p < 0.001 and p < 0.01, respectively). An AAG value >63 mg/dl in a pleural effusion is predictive of an exudate with a sensitivity of 90% and a specificity 85%. Similarly, an AMG value >44 mg/dl in a pleural effusion is predictive of an exudate with a sensitivity and a specificity of 90% and 60%, respectively. Moreover, pleural AAG was significantly higher in cancerous exudates than in exudates and transudates of all other cause taken together (p < 0.001). Finally, to differentiate the same pleural effusion, the cut-off value of 1.0 mg/dl of pleural CRP has a sensitivity and a specificity of 74% and 74%, respectively. Conclusions: We conclude that both AAG and AMG concentrations in pleural effusions have a high sensitivity and are therefore useful parameters in distinguishing exudates from transudates, but the latter is inferior due to its unacceptably low specificity.

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“…Other exudate/transudate studies have looked at the use of pleural fluid cholesterol (9), albumin gradient (10) and serum/fluid bilirubin ratio (11); however, these have been shown to be less accurate than Light’s criteria (12). The weakness of Light’s criteria is that approximately 20% of heart failure‐related effusions in patients taking diuretic therapy are identified as exudates (13).…”

Section: Investigation – Pleural Fluidmentioning

confidence: 99%

A systematic approach to the investigation and diagnosis of a unilateral pleural effusion

McGrath

Blades

Needham

et al. 2009

International Journal of Clinical Practice

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Summary Fluid in the pleural space is a common sequela of a wide range of diseases which may be pulmonary, pleural or extrapulmonary. As the differential diagnosis is wide, a systematic approach to investigation and diagnosis is recommended. This review highlights the important features and recommendations for the investigation of a unilateral pleural effusion, a common condition encountered by the general physician. The aim of this study was to assist with a speedy diagnosis of the underlying pathology, using appropriate investigative techniques, while minimising the use of invasive procedures.

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Pleural Cholesterol in Differentiating Transudates and Exudates

Cited by 32 publications

References 11 publications

Pleural Interleukin-1β in Differentiating Transudates and Exudates: Comparative Analysis with Other Biochemical Parameters

Pleural Interleukin-1β in Differentiating Transudates and Exudates: Comparative Analysis with Other Biochemical Parameters

Significance of Alpha-2-Macroglobulin, Alpha-1-Acid Glycoprotein, and C-Reactive Protein in Pleural Effusion Differentiation

A systematic approach to the investigation and diagnosis of a unilateral pleural effusion

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