Differentiating transudative from exudative pleural effusion: should we measure effusion cholesterol dehydrogenase?

Mathie P.G. Leers 1 , 1 , Henne A. Kleinveld 2 , 2  and Volkher Scharnhorst 3 , 3
  • 1 Department of Clinical Chemistry and Hematology, Atrium Medical Center Heerlen, Heerlen, The Netherlands
  • 2 Department of Clinical Chemistry and Hematology, Atrium Medical Center Heerlen, Heerlen, The Netherlands
  • 3 Department of Clinical Chemistry and Hematology, Atrium Medical Center Heerlen, Heerlen, The Netherlands Present address: Catharina Hospital, Clinical Laboratory, Eindhoven, The Netherlands

Abstract

Introduction: Pleural effusions are often classified into transudates and exudates based on Light's criteria. In this study, the diagnostic properties of Light's criteria were compared to those of several other analytes for the classification of pleural fluids into transudative and exudative.

Methods: A total of 471 patients with pleural effusions were evaluated. In pleural effusions and simultaneously drawn blood samples, lactate dehydrogenase (LDH), total protein, albumin, cholesterol, amylase, glucose, pH and the cell number were measured. Retrospectively, the clinical records were used to establish a clinical diagnosis. The diagnostic properties of the biochemical tests were calculated using the clinical diagnoses as gold standard.

Results: By clinical diagnosis, 108 patients had transudative and 300 patients had exudative pleural effusions. In addition to pleural LDH activity (accuracy 89%, sensitivity 86%, specificity 97%) and fluid to serum LDH ratio (accuracy 89%, sensitivity 91%, specificity 85%), pleural cholesterol concentration readily identified exudates (accuracy 82%, sensitivity 76%, specificity 98%). Combination of these three parameters achieved a higher overall accuracy (accuracy 95%, sensitivity 93%, specificity 100%) than the Light's criteria (accuracy 93%, sensitivity 100%, specificity 73%). Combination of effusion cholesterol concentration and effusion LDH activity had the highest discriminatory potential (accuracy 98%, sensitivity 98%, specificity 95%).

Conclusions: Including effusion cholesterol, concentration in the routine biochemical work-up of pleural fluid allows for correct classification of more pleural effusions than achieved by use of Light's criteria. Combination of cholesterol and LDH had the highest discriminatory potential and the added advantage that no patient plasma is needed for correct classification.

Clin Chem Lab Med 2007;45:1332–8.

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Clinical Chemistry and Laboratory Medicine ( CCLM) publishes articles on novel teaching and training methods applicable to laboratory medicine. CCLM welcomes contributions on the progress in fundamental and applied research and cutting-edge clinical laboratory medicine. It is one of the leading journals in the field, with an impact factor of over three. CCLM is the official journal of nine national clinical societies and associated with EFLM.

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