Simplified criteria using pleural fluid cholesterol and lactate dehydrogenase to distinguish between exudative and transudative pleural effusions

Pierre Alexis Lépine, Rajesh Thomas, Sébastien Nguyen, Yves Lacasse, Hui Min Cheah, Jenette Creaney, Sanjeevan Muruganandan, Simon Martel, Y. C.Gary Lee, Antoine Delage

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Abstract

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.

Original languageEnglish
Number of pages7
JournalRespiration
DOIs
Publication statusE-pub ahead of print - 1 Mar 2019

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Pleural Effusion
L-Lactate Dehydrogenase
Cholesterol
Exudates and Transudates
Serum
ROC Curve
Medical Records
Cohort Studies
Costs and Cost Analysis
Sensitivity and Specificity
Thoracentesis

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Lépine, Pierre Alexis ; Thomas, Rajesh ; Nguyen, Sébastien ; Lacasse, Yves ; Cheah, Hui Min ; Creaney, Jenette ; Muruganandan, Sanjeevan ; Martel, Simon ; Lee, Y. C.Gary ; Delage, Antoine. / Simplified criteria using pleural fluid cholesterol and lactate dehydrogenase to distinguish between exudative and transudative pleural effusions. In: Respiration. 2019.
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Simplified criteria using pleural fluid cholesterol and lactate dehydrogenase to distinguish between exudative and transudative pleural effusions. / Lépine, Pierre Alexis; Thomas, Rajesh; Nguyen, Sébastien; Lacasse, Yves; Cheah, Hui Min; Creaney, Jenette; Muruganandan, Sanjeevan; Martel, Simon; Lee, Y. C.Gary; Delage, Antoine.

In: Respiration, 01.03.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Simplified criteria using pleural fluid cholesterol and lactate dehydrogenase to distinguish between exudative and transudative pleural effusions

AU - Lépine, Pierre Alexis

AU - Thomas, Rajesh

AU - Nguyen, Sébastien

AU - Lacasse, Yves

AU - Cheah, Hui Min

AU - Creaney, Jenette

AU - Muruganandan, Sanjeevan

AU - Martel, Simon

AU - Lee, Y. C.Gary

AU - Delage, Antoine

PY - 2019/3/1

Y1 - 2019/3/1

N2 - 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.

AB - 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.

KW - Light's criteria

KW - Pleural cholesterol

KW - Pleural effusion

KW - Pleural lactate dehydrogenase

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U2 - 10.1159/000496396

DO - 10.1159/000496396

M3 - Article

JO - Respiration

JF - Respiration

SN - 0025-7931

ER -