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PubMedDate not supplied

Differentiation of exudate from transudate ascites by Doppler sonography.

BACKGROUND: We investigated whether the addition of Doppler sonography (US) increases the diagnostic confidence of US for estimating the nature of ascites. METHODS: Of the 127 cases reviewed in this study, there were 42 cases of transudate and 85 of exudate ascites. We reviewed the US, power Doppler, and pulsed Doppler images of these cases. RESULTS: With US, the transudate ascites was imaged as free of echo in 38 of 42 cases (90.5%). The exudate ascites was imaged as free of echo in 22 of 85 cases (25.9%) and with internal echo spots in 63 of 85 cases (74.1%). With Doppler US, we obtained distinct pulsed signals from the transudate ascites in only two of 36 cases (5.6%). In contrast, we obtained distinct Doppler signals from the exudate ascites in 66 of 79 cases (83.5%). Those 66 cases included 16 of the 22 cases with echo-free ascites. CONCLUSION: The presence or absence of echo spots within the ascites helped differentiate transudate from exudate ascites, as reported in the literature. However, the addition of Doppler US contributed to the differentiation of echo-free exudate (Doppler signals present) from echo-free transudate (Doppler signals absent) ascites.

Abdomen↗
PubMed1998

Pleural fluid: accuracy of computed tomography in differentiating exudates from transudates.

PURPOSE: To determine the accuracy of computed tomography in differentiating pleural exudates from transudates when reviewed subjectively by two experienced radiologists in a community hospital. METHODS: Computed tomography scans of 55 consecutive patients who had a thoracenteses within 10 days of the study were retrospectively reviewed independently by two experienced staff radiologists. They were asked to evaluate subjectively parietal pleural thickness (anterior, lateral, posterior), attenuation of extra-pleural fat, and categorize pleural fluid as loculated or free flowing. Radiographic findings were correlated with biochemical results of thoracentesis (Light's criteria) to assess the accuracy of computed tomography in differentiating pleural exudates from transudates. RESULTS: For the diagnosis of an exudate, pleural thickening alone had the best sensitivity and specificity (50%, 100%, respectively) with an accuracy of 55%. CONCLUSION: Subjective evaluations for increased pleural thickness have a high accuracy for diagnosing pleural exudates.

Exudates and Transudates↗
PubMed1991

[The differential diagnosis between pleural exudates and transudates: the value of cholesterol].

BACKGROUND: The evaluation of a patient with pleural effusion depends on its classification as exudate or transudate. Many criteria have been established but none has a 100% sensitivity and specificity. The aim of the present study was to assess the value of the cholesterol level to differentiate between exudate and transudate and to establish its utility as compared with other differential criteria. METHODS: 104 patients with pleural effusion of well defined etiology, permitting their classification into 56 exudates and 48 transudates, were evaluated. In all, Light's criteria were established and cholesterol values in pleural effusion and serum were measured and compared. RESULTS: Using the lactate dehydrogenase level (LDH) in pleural fluid (PF) and the ratios of LDH and proteins in PF and serum, 100% of exudates and 83% of transudates were correctly classified. A cholesterol level of 40 mg/dl or higher best separated exudates and transudates, with a sensitivity of 96% and a specificity of 92% for exudates. A ratio of 0.3 or higher between cholesterol levels in PF and serum was shown to have a high sensitivity (96%) and lower specificity (85%) for exudates. The highest specificity (92%) was achieved when the protein ratio in PF and serum was combined with PF cholesterol. CONCLUSIONS: The cholesterol level in pleural fluid and the ratio between this value and that in serum are highly useful parameters to differentiate between exudates and transudates.

Cholesterol↗
PubMed2005

A simple laboratory measurement for discrimination of transudative and exudative pleural effusion: pleural viscosity.

BACKGROUND: The initial step in establishing the cause of an effusion is to determine whether the fluid is a transudate or exudate. Plasma viscosity is influenced by the concentration of plasma proteins and lipoproteins with the major contribution resulting from fibrinogen. In this study we aimed to evaluate the role of pleural fluid viscosity in discrimination of transudate and exudates. MATERIALS AND METHODS: We studied prospectively 63 consecutive patients with pleural effusion in whom diagnostic or therapeutic thoracentesis had been performed. The criteria of Light were applied to differentiate transudates from exudates: 33 patients (23 male, 13 female, mean age=68+/-4 years) had exudates and 30 patients (17 male, 13 female, mean age=68+/-5) had transudates (due to congestive heart failure). Measurements of pleural fluid and plasma viscosity were performed using a viscometer. RESULTS: There was no statistically significant difference between patients with transudate and exudates in respect to plasma viscosity. However, pleural viscosities of the patients with exudates were significantly higher than those of patients with transudate (1.37+/-0.16 mPa vs 0.93+/-0.03 mPa s p<0.001, respectively). Pleural viscosity has a high sensitivity, specificity (94%, 93%, respectively), positive and negative predictive value (97%, 97%, respectively) for the discrimination of transudative or exudatetive pleural fluid. CONCLUSION: We have demonstrated for the first time that pleural viscosity of the exudative effusion is higher than that of transudative effusion with high sensitivity, specificity, positive and negative predictive value. Regarding the simplicity of this measurement, it may play a valuable role in the accurate and fast discrimination of pleural fluid.

Aged↗
PubMed2004

[Distinguishing pleural transudates and exudates through the quantification of biochemical parameters].

OBJECTIVES: 1) to evaluate the possibility of distinguishing pleural transudates and exudates through the joint determination of 26 biochemical parameters in pleural effusion and in plasma (including the determination of high molecular weight proteins, acute phase reactants, and proinflammatory citokines), and 2) to formulate a logistic regression equation for optimizing the classification efficiency, comparing the equation obtained with Light's criteria. PATIENTS AND METHODS: All diagnostic thoracocentesis carried out in La Rioja Autonomous Community during a 22-month period were evaluated. The 245 clinical records were evaluated periodically along a minimum of 2 years, after the discharge of the patients. In pleural effusion and in plasma the following were quantified: total proteins, LDH, glucose, amylase, cholesterol, albumin, cholinesterase, phosphatase alkaline, urea, beta2-microglobulin, IgG, IgM, alpha2-macroglobulin, C reactive protein, transferrin, alpha1-antitrypsin, serum amyloid A protein, interleukin 1-beta, interleukin 6, tumoral necrosis factor-alpha, and lysozyme. In addition, the cellularity, polymorphonuclear elastase and adenosine deaminase were evaluated in pleural fluid. RESULTS: The LDH pleural effusion/plasma ratio was the individual parameter that showed higher area under the receiver operating characteristic curve for the separation of pleural transudates and exudates. Interleukin 6 and tumoral necrosis factor-alpha showed pleural effusion/plasma ratios higher than the unit, which suggests an in situ citokines production. An predictive logistic regression equation was obtained that incorporates only LDH and cholesterol ratios, including the diuretic treatment of the patient at the time of thoracocentesis, which did not modify the protein concentrations in pleural effusion. Except for LDH ratio, the logistic regression equation showed an area under the receiver operating characteristic curve higher than that of all the evaluated individual parameters, with a sensitivity of 95% and a specificity of 85% (70% for the Light's criteria). CONCLUSIONS: LDH ratio is the best individual parameter for distinguishing pleural transudates and exudates. The additional evaluation of cholesterol ratio and of the diuretic state of the patient make possible to improve the clinical efficiency of this classification. The quantification of high molecular weight proteins, acute phase reactants and citokines does not contribute additional significant information.

Adult↗
PubMedDate not supplied

Role of pleural fluid cholesterol in differentiating transudative from exudative pleural effusion.

BACKGROUND: Pleural fluid cholesterol has been reported to be useful in distinguishing between transudative and exudative pleural effusion. However, the difference in lipid profile between tubercular and non-tubercular pleural effusion has not been studied. METHODS: The lipid profile of pleural fluid in 50 patients with exudative (25 tubercular and 25 non-tubercular) and 25 with transudative effusion was studied. The diagnosis was based on clinical criteria and/or a positive diagnosis from another site. RESULTS: The criteria that best identified an exudative pleural effusion were pleural fluid cholesterol > or = 60 mg/dl, pleural fluid to serum cholesterol ratio > or = 0.4, pleural fluid triglyceride > or = 40 mg/dl and pleural fluid to serum triglyceride ratio > or = 0.3. Pleural fluid cholesterol had a sensitivity of 88% and a specificity of 100% for exudates with an accuracy of 92%. Pleural fluid to serum cholesterol ratio had a sensitivity of 98% and a specificity of 84%. These results were superior to the criteria proposed by Light et al. (sensitivity 98% and specificity 80%). CONCLUSION: Pleural fluid cholesterol estimation is an effective and cost-efficient method of differentiating exudative from transudative pleural effusion. The lipid profile does not help in diagnosing tubercular effusion.

Adult↗
PubMed2003

Diffusion-weighted MR imaging of pleural fluid: differentiation of transudative vs exudative pleural effusions.

The aim of this study was to evaluate the ability of diffusion-weighted MRI in differentiating transudative from exudative pleural effusions. Fifty-seven patients with pleural effusion were studied. Diffusion-weighted imaging (DWI) was performed with an echo-planar imaging (EPI) sequence (b values 0, 1000 s/mm(2)) in 52 patients. The apparent diffusion coefficient (ADC) values were reconstructed from three different regions. Subsequently, thoracentesis was performed and the pleural fluid was analyzed. Laboratory results revealed 20 transudative and 32 exudative effusions. Transudates had a mean ADC value of 3.42+/-0.76 x 10(-3) mm(2)/s. Exudates had a mean ADC value of 3.18+/-1.82 x 10(-3) mm(2)/s. The optimum cutoff point for ADC values was 3.38 x 10(-3) mm(2)/s with a sensitivity of 90.6% and specificity of 85%. A significant negative correlation was seen between ADC values and pleural fluid protein, albumin concentrations and lactate dehydrogenase (LDH) measurements ( r=-0.69, -0.66, and -0.46, respectively; p<0.01). The positive predictive value, negative predictive value, and diagnostic accuracy of ADC values were determined to be 90.6, 85, and 88.5%, respectively. The application of diffusion gradients to analyze pleural fluid may be an alternative to the thoracentesis. Non-invasive characterization of a pleural effusion by means of DWI with single-shot EPI technique may obviate the need for thoracentesis with its associated patient morbidity.

Diagnosis, Differential↗
PubMed1994

[Cholesterol in pleural fluid. Its usefulness in differentiating between exudates and transudates].

To analyze the usefulness of cholesterol levels in the differentiation of exudates and transudates. A 3.5-year prospective study of 170 patients with pleural discharge. Clinical microbiological and cyto-histological criteria were used for diagnosis. Exudates were classified by Light's criteria, by cholesterol > or = 45 mg/dl in pleural liquid, by a cholesterol in pleural liquid/cholesterol in serum quotient > or = 0.3 and by a finding of both LDH and cholesterol in pleural fluid. These criteria were compared with the final etiological diagnosis. Only pleural discharges with confirmed etiological diagnoses were analyzed. In the 130 pleural discharges for which certain etiological diagnoses were obtained, 33 were transudates and 97 were exudates. Light's criteria allowed accurate classification of 92 (95%) of the 97 exudates and 30 (91%) of the 33 transudates. The cholesterol in pleural liquid/cholesterol in serum quotient was the most productive and useful parameter (96% sensitivity, 97% specificity), better than pleural fluid cholesterol and the Light's criteria. The association of LDH and pleural fluid cholesterol classified 100% of the exudates, with efficacy similar to that of Light's criteria. The cholesterol in pleural fluid/serum quotient was the most useful biochemical variable. Cholesterol levels were about as useful as Light's criteria. The association of LDH and cholesterol allows us to bypass blood analyses for the diagnosis of exudates.

Adolescent↗
PubMedDate not supplied

Evaluation of ferritin, interleukin-6, interleukin-8 and tumor necrosis factor alpha in the differentiation of exudates and transudates in pleural effusions.

In an attempt to define diagnostic criteria for the differentiation of pleural exudates from transudates, we measured ferritin (FER), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) in pleural effusions and blood serum in 84 consecutive patients with pleural effusions of various etiologies. Concentrations of FER, IL-8 and TNF-alpha were significantly higher in serum and pleural effusion in patients with exudates than in patients with transudates. Serum concentrations of IL-6 were not significantly increased in pleural exudate patients (9.78 +/- 17.12 fmol/L) compared to transudate patients (4.05 +/- 2.33 fmol/L), while significant differences were found between pleural exudates and transudates (p < 0.001). Increased levels of FER were found in serum and pleural effusion of cancer patients in comparison to non cancer patients (p < 0.001 and p < 0.001, respectively). Serum concentrations of IL-6, IL-8, and TNF-alpha were not significantly increased in cancer compared to non-cancer patients, while increased concentrations of IL-6 and IL-8 were found in pleural fluid of patients with cancer in comparison to non-cancer patients. Finally/ no statistically significant differences were found in serum and pleural TNF-alpha concentrations among patients with cancer and patients with non-cancer effusion. We conclude that FER, IL-6, IL-8 and TNF-alpha concentrations in pleural effusions are useful markers in differentiating exudates from transudates.

Adult↗
PubMed2000

Light's criteria revisited: consistency and comparison with new proposed alternative criteria for separating pleural transudates from exudates.

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.

Adolescent↗
PubMed1995

Measurement of pleural fluid cholesterol and lactate dehydrogenase. A simple and accurate set of indicators for separating exudates from transudates.

OBJECTIVES: To evaluate the usefulness of diverse combinations of pleural cholesterol concentration, pleural or serum protein, and lactate dehydrogenase (LDH) levels for the differentiation of pleural exudates and transudates. DESIGN: Prospective laboratory study of pleural effusions. SETTING: Medical school hospital. PATIENTS: One hundred eighty consecutive internal medicine ward patients in whom the etiologic diagnosis of their pleural effusion was confirmed. MEASUREMENTS: Cholesterol concentration in pleural fluid and protein and LDH both in pleural fluid and blood serum. RESULTS: According to their etiology, 49 (27.2%) of the effusions were transudates and 131 (72.7%) were exudates. Using a cutoff point of 45 mg for pleural cholesterol and values for protein and LDH of Light et al, the best diagnostic power corresponded to the combination of pleural cholesterol and LDH: cholesterol level over 45 mg/dL and/or LDH over 200 IU/L identified exudates with a sensitivity of 99% and a specificity of 98%. All the other combinations showed inferior values and the criteria of Light et al reached 98 and 82%, respectively. CONCLUSIONS: The measurement of pleural cholesterol and LDH permits the separation of pleural exudates from transudates with an accuracy similar to the original report of Light et al, with the advantage of requiring only two laboratory determinations and no simultaneous blood sample.

Cholesterol↗
PubMed1996

[Pleural effusion: criteria for distinguishing between transudates and exudates].

The first step in the diagnostic study of a pleural effusion is to classify as a transudate or exudate. Light's criteria (pleural fluid/serum proteines > 0.5; lactatedehydrogenase [LDH] > 2/3 of the upper normal limit in serum; pleural fluid/serum LDH > 0.6) usually used, incorrectly classify some cases, especially transudates. For this reason, different alternative criteria has been proposed: pleural fluid cholesterol, pleural fluid/serum cholesterol ratio, pleural fluid/serum bilirubin ratio, and serum/pleura albumin ratio. Althought the first results suggested better results that those obtained with the Light's criteria, after the analysis of the different studys we conclude that a method to diferentiate perfectly transudates and exudates is not yet available.

Cholesterol↗
PubMed2004

The separation of transudates and exudates with particular reference to the protein gradient.

PURPOSE OF REVIEW: The separation of pleural transudates from exudates, as the first step in the study of pleural effusions of unknown cause, is generally accepted as a useful practice. However, the optimal way to do this remains moot. RECENT FINDINGS: New and more sophisticated biochemical markers have been proposed together, with new approaches to the interpretation of the results. Nevertheless, new studies have consolidated the criteria of Light et al. as those with a better accuracy. Effective diuresis increases the concentration of most pleural biochemical parameters used to differentiate transudates from exudates and appears as the main cause of the failures of this dichotomic approach. Among the alternative criteria proposed for identifying transudates in the setting of diuresis, the total protein gradient between serum and pleural fluid seems to be the most cost effective. SUMMARY: Together with clinical judgment, the use of biochemical criteria seems mandatory. The criteria of Light et al. remain those of election. In the setting of effective diuresis, the use of the protein gradient is recommended. Although new and more sophisticated markers have been tested, it seems that looking for the causes of misclassification, when applying the criteria that to date have shown better efficiency, deserves preferential investigation.

Albumins↗
PubMed2004

NT-brain natriuretic peptide levels in pleural fluid distinguish between pleural transudates and exudates.

BACKGROUND: Pleural effusion is not pathognomic and distinguishing between transudates and exudates often presents a diagnostic dilemma. The purpose of our study was to examine whether the inclusion of pleural fluid brain natriuretic peptide (BNP) measurement into the analysis improves the diagnostic accuracy of pleural effusion. METHODS: The pleural effusion of 14 patients with CHF (group A) and 14 subjects with different pleural pathology (group B) were analyzed. Samples of pleural fluid and serum were obtained from all patients on admission and biochemical analysis, bacterial and fungal culture, acid-fast bacilli smear and culture and cytology were performed on the pleural fluid. In vitro quantitative determination of N-terminal pro-Brain natriuretic peptide (NT-proBNP) in serum and pleural fluid were performed by electrochemiluminescence immunoassay proBNP method on an Elecsys 2010 (Roche) analyzer. RESULTS: The median NT-proBNP levels in groups A and B were 6295 pg/ml and 276 pg/ml, respectively: (P=0.0001). There was no overlap between the two groups. While the Light's criteria had a sensitivity of 93% and specificity of 43% for transudates, the pleural fluid NT-proBNP level accurately differentiated between the two groups. CONCLUSIONS: The pleural NT-proBNP levels were elevated in all patients who had transudate. Therefore if the NT-proBNP levels of pleural effusion are within the normal range, transudate resulting from congestive heart failure can be ruled out. Our results suggest that the inclusion of pleural fluid NT-proBNP measurement in the routine diagnostic panel would enhance discrimination among the different causes of pleural effusions.

Aged↗
PubMed2000

Diagnostic value of uric acid to differentiate transudates and exudates.

Uric acid is known to be an end product of purine metabolism. Increases in uric acid may be found in clinical conditions associated with tissue hypoxia. We have investigated the value of uric acid to differentiate between a transudate and exudate. In this study, we measured uric acid in the pleural fluid and the serum of 110 patients, 30 women and 80 men with a mean age of 49.5+/-19 years. Light's criteria were used to differentiate between a transudate and exudate. Mean serum uric acid was 496.7+/-153.4 micromol/l in patients with transudates and 291.3+/-143.1 micromol/l in patients with exudates. Mean pleural fluid uric acid was 487.7+/-165 micromol/l in patients with transudates and 279.9+/-142.1 micromol/l in patients with exudates. These data showed that the levels of serum and pleural uric acid were higher in transudates than exudates (p<0.01). However, there was no significant difference between pleural fluid/serum uric acid ratio of the two patient groups (p>0.05). The specificity and sensitivity of pleural uric acid for diagnosis of transudate effusions were 73% and 80.6%, respectively. The specificity and sensitivity of pleural uric acid for diagnosis of transudate effusions from exudates without malignancy were 71.8% and 91.7%, respectively. The sensitivity and specificity of pleural lactate dehydrogenase for diagnosis of exudates were 82% and 89%; the sensitivity and specificity of pleural fluid/serum lactate dehydrogenase were 85% and 89%; the sensitivity and specificity of pleural fluid/serum protein were 91% and 89%, respectively. Using all three of Light's criteria together, the sensitivity was 91% and its specificity was 94%. Our findings indicate that determination of uric acid in pleural fluid may be of diagnostic value in differential diagnosis of transudates and exudates. The sensitivity of pleural uric acid measurement was higher for exudates without malignancy. However, Light's criteria remain the best means of separating transudates from exudates.

Adult↗