Öz
Aim: It is important in the diagnosis of pleural effusions is to make a discrimination between transudates (T) and exudates (E). The purpose of our study is to measure the sensitivity and specificity of Light’s criteria and single,double and triple tests including pleural liquid cholesterol in discrimination of T-E.
Materials and Methods: This study included 145 patients. Pleural fluid cholesterol>45 mg/dL(single test) or pleural fluid LDH greater than 45% upper limit of normal blood LDH was defined as exudates (double test). Pleural fluid protein >2.9 g/dL or pleural fluid cholesterol>45 mg/dL or pleural fluid LDH greater than 45% upper limit of normal blood LDH was defined as exudates (triple test). The expected type of pleural effusion to be appropriate for definitive diagnosis was considered as the gold standard.
Results: When a total of 139 patients were grouped according to their definitive diagnosis, the expected type of pleural effusion was determined as exudative in 81% and transudative in 19%. In the detection of exudative pleural fluid, single test was compared with definitive diagnosis and borderline significance was found between the two groups (p=0.05). In the double and triple test assessments, there was a statistically significant difference between the two groups in both analyzes (p<0.001). The single test had a sensitivity of 88.5%, a specificity of 84.6%. Both the double and triple tests had a sensitivity of 100%, but their specificity rates were lower (respectively,46.1% and 42.3%).
Conclusion: The results obtained in our study group did not support that single, double or triple test can be used in the detection of exudative pleural fluid instead of Light's criteria.
Anahtar Kelimeler
Kaynakça
- Metintaş S. Plevral efüzyon epidemiyolojisi. Toraks kitapları, sayı 4, Ekim 2003, 16-25.
- Light RW, Macgregor MI, Lunchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic seperation of transüdates and exudates. Ann Intern Med 1972; 77: 507-13.
- McGrath EE, Anderson PB: Diagnosis of pleural effusions: a systematic approach. Am J Crit Care 2011; 20: 119-27.
- Valdes L, San-Jose E, Estevez JC, et al. Cholesterol in pleural exudates depends mainly on increased capillary permeability. Transl Res 2010; 155 (4): 178-84.
- Heffner JE, Brown LK, Barbieri CA. Diagnostic value of tests that discriminate between exudative and transüdative pleural effusions. Chest 1997; 111 (4): 970-80.
- Heffner JE, Sahn SA, Brown LK. Multilevel likelihood ratios for identifying exudative pleural effusions. Chest 2002; 121 (6): 1916-20.
- Porcel JM, Pena JM, Vera CV, Esquerda A, Vives M, Light RW. Bayesian analysis using continuous likelihood ratios for identifying pleural exudates. Respiratory Medicine 2006; 100: 1960-5.
- Shen Y, Zhu H, Wan C, et al. Can cholesterol be used to distinguish pleural exudates from transüdates? Evidence from a bivariate meta-analysis. BMC Pulmonary Medicine 2014; 14: 61-9.
- Rungta R, Jha RK. Comparative analysis of pleural fluid biochemical parameters with cholesterol to differentiate transüdates from exudates. The Journal of Association of Chest Physicians 2013; 1 (2): 54-7.
- Hamal AB, Yogi KN, Bam N, Das SK, Karn R. Pleural fluid cholesterol in differentiating exudative and transudative pleural effusion. Pulm Med. 2013; 2013: 135036.
- Gözü A, Uğurman F, Akkalyoncu B, Eryılmaz T, Samurkaşoğlu B, Önde G. Plevral sıvıların eksuda-transüda ayırımında, Light kriterleri, albümin gradiyenti, kolesterol, ürik asit ve lipoprotein fraksiyonlarının karşılaştırılmalı analizi. Türkiye Klinikleri Archives of Lung. 2000; 1 (3): 13-8.
- Dhandapani S, Reddy S, Rajagopalan R. Differentiating pleural effusions: Criteria based on pleural fluid cholesterol. Eurasian J Pulmonol 2016; 18 (2): 76-9.
- Rufino R, Marques BL, Azambuja RL, Mafort T, Pugliese JG, Costa CH. Pleural cholesterol to the diagnosis of exudative effusion. The Open Respiratory Medicine Journal 2014; 8: 14-7.
- Wilcox ME, Chong CAKY, Stanbrook MB, Tricco AC, Wong C, Straus SE. Does this patient have an exudative pleural effusion? The rational clinical examination systematic review. JAMA 2014; 311: 2422-31.
- Majhi C, Pradhan B, Nanda BC, Tripathy S. Pleural fluid cholesterol level is an important parameter in differentiating exudative from transüdative pleural effusions. Int J Adv Med 2018; 5 (3): 520-4.
- Lepine PA, Thomas R, Nguyen S, et al. Simplified criteria using pleural fluid cholesterol and lactate dehydrogenase to distinguish between exudative and transüdative pleural effusions. Respiration 2019; 98: 48-54.
Öz
Amaç: Plevral sıvıların tanısında, transüda (T)–eksuda (E) ayrımının yapılması önemlidir. Bu çalışmanın amacı, Light kriterleri ile plevral sıvı kolesterol düzeyini içeren tekli, ikili ve üçlü testlerin, T-E ayırımındaki duyarlılık ve özgüllüğünü belirlemektir.
Gereç ve Yöntem: Çalışmaya plevral sıvı nedeniyle başvuran 145 hasta dâhil edildi. Plevral sıvı kolesterol düzeyi (PSKD) ≥45 mg/dL (tekli test); PSKD ≥45 mg/dL veya plevral sıvı LDH düzeyi >kan normal LDH’sının %45 (ikili test); plevral sıvı protein >2,9 g/dL, PSKD ≥45 mg/dL, plevral sıvı LDH düzeyi >kan normal LDH’sının %45 (üçlü test) olarak tanımlandı. Kesin tanıya uygun beklenen plevral sıvı tipi altın standart olarak değerlendirmeye alındı.
Bulgular: Çalışmaya alınan 139 hastada, kesin tanıya uygun beklenen plevral sıvı tipi olguların %81’inde eksuda; %19’unda transüda olarak belirlendi. Eksudatif plevral sıvıyı saptamada, tekli testin kesin tanıya uygun beklenen plevral sıvı tipi ile karşılaştırılmasında iki grup arasında sınırda anlamlılık saptandı (p=0.05). İkili ve üçlü test değerlendirmelerinde ise iki grup arasında istatistiki anlamlı fark saptandı (p<0.001). Tekli testin duyarlılığı %88,5, özgüllüğü %84,6; ikili ve üçlü testin ise duyarlılığı %100 olmasına karşın, özgüllükleri düşüktü (sırasıyla, %46,1 ve %42,3).
Sonuç: Hasta grubumuzdaki bulgular, eksudatif plevral sıvının saptanmasında plevral sıvı kolesterol düzeyini içeren tekli, ikili veya üçlü testlerin, Light kriterlerinin yerine kullanılabilmesini desteklememiştir.
Anahtar Kelimeler
Kaynakça
- Metintaş S. Plevral efüzyon epidemiyolojisi. Toraks kitapları, sayı 4, Ekim 2003, 16-25.
- Light RW, Macgregor MI, Lunchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic seperation of transüdates and exudates. Ann Intern Med 1972; 77: 507-13.
- McGrath EE, Anderson PB: Diagnosis of pleural effusions: a systematic approach. Am J Crit Care 2011; 20: 119-27.
- Valdes L, San-Jose E, Estevez JC, et al. Cholesterol in pleural exudates depends mainly on increased capillary permeability. Transl Res 2010; 155 (4): 178-84.
- Heffner JE, Brown LK, Barbieri CA. Diagnostic value of tests that discriminate between exudative and transüdative pleural effusions. Chest 1997; 111 (4): 970-80.
- Heffner JE, Sahn SA, Brown LK. Multilevel likelihood ratios for identifying exudative pleural effusions. Chest 2002; 121 (6): 1916-20.
- Porcel JM, Pena JM, Vera CV, Esquerda A, Vives M, Light RW. Bayesian analysis using continuous likelihood ratios for identifying pleural exudates. Respiratory Medicine 2006; 100: 1960-5.
- Shen Y, Zhu H, Wan C, et al. Can cholesterol be used to distinguish pleural exudates from transüdates? Evidence from a bivariate meta-analysis. BMC Pulmonary Medicine 2014; 14: 61-9.
- Rungta R, Jha RK. Comparative analysis of pleural fluid biochemical parameters with cholesterol to differentiate transüdates from exudates. The Journal of Association of Chest Physicians 2013; 1 (2): 54-7.
- Hamal AB, Yogi KN, Bam N, Das SK, Karn R. Pleural fluid cholesterol in differentiating exudative and transudative pleural effusion. Pulm Med. 2013; 2013: 135036.
- Gözü A, Uğurman F, Akkalyoncu B, Eryılmaz T, Samurkaşoğlu B, Önde G. Plevral sıvıların eksuda-transüda ayırımında, Light kriterleri, albümin gradiyenti, kolesterol, ürik asit ve lipoprotein fraksiyonlarının karşılaştırılmalı analizi. Türkiye Klinikleri Archives of Lung. 2000; 1 (3): 13-8.
- Dhandapani S, Reddy S, Rajagopalan R. Differentiating pleural effusions: Criteria based on pleural fluid cholesterol. Eurasian J Pulmonol 2016; 18 (2): 76-9.
- Rufino R, Marques BL, Azambuja RL, Mafort T, Pugliese JG, Costa CH. Pleural cholesterol to the diagnosis of exudative effusion. The Open Respiratory Medicine Journal 2014; 8: 14-7.
- Wilcox ME, Chong CAKY, Stanbrook MB, Tricco AC, Wong C, Straus SE. Does this patient have an exudative pleural effusion? The rational clinical examination systematic review. JAMA 2014; 311: 2422-31.
- Majhi C, Pradhan B, Nanda BC, Tripathy S. Pleural fluid cholesterol level is an important parameter in differentiating exudative from transüdative pleural effusions. Int J Adv Med 2018; 5 (3): 520-4.
- Lepine PA, Thomas R, Nguyen S, et al. Simplified criteria using pleural fluid cholesterol and lactate dehydrogenase to distinguish between exudative and transüdative pleural effusions. Respiration 2019; 98: 48-54.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 22 Aralık 2021 |
| Gönderilme Tarihi | 8 Aralık 2020 |
| Yayımlandığı Sayı | Yıl 2021Cilt: 60 Sayı: 4 |
