Ana Sayfa | Dergi Hakkında | Yayın Kurulu | Bilimsel Danışma Kurulu | İçindekiler | Arşiv | Yayın Arama | Yazarlara Bilgi | İletişim  
2017, Cilt 31, Sayı 3, Sayfa(lar) 157-164   
IS IT POSSIBLE TO DIFFERENTIATE BETWEEN EXUDATE AND TRANSUDATE ONLY BY STANDARD BIOCHEMICAL PARAMETERS IN PLEURAL FLUID?
Ülkü AKA AKTÜRK, Dilek ERNAM, Nagihan DURMUŞ KOÇAK, Makbule Özlem AKBAY
Süreyyaşa Göğüs Hastalıkları ve Göğüs Cerrahisi EAH, Göğüs Hastalıkları, İstanbul, Türkiye
Keywords: Exudative, transudative,pleural fluid

Aim: The pleural fluid often presents diagnostic and clinical problems.The first step in the examination of pleural effusion is to differentiate between transudate and exudate.The aim of this study was to evaluate the clinical utility of standard pleural fluid parameters in the differentiation of transudative and exudative pleural effusion in tuberculosis endemic country.

Material and methods: The records of patients who had pleural fluid analysis between 1 May 2013 and 1 March 2015 were electronically obtained.On the basis of the classification according to certain diagnosis after the careful evaluation of clinical data and diagnostic procedures, the cut-off values of pleural lactate dehydrogenease(LDH), total protein(TP) and adenosine deaminase(ADA) were determined. The sensitivity and spesifity of these parameters used in exudate-transudate differentiation were calculated and compared with Light’s criteria.

Results: Totally 1433 precisely diagnosed patients with appropriate criteria were included in the study. On the basis of certain diagnosis 75.1% of them were exudate and 24.9% of them were transudate. When 171 IU/L was taken as the cut-off value of pleural LDH, the rates of sensitivity, specificity were 85% and over, while 3.2 g/L was taken as the cut-off value of the pleural total protein, the rates of sensitivity and spesifity were between 72 % - 85 %. The most appropriate combination parameters for clinical use were those of LDH at the level of 171 IU/L and total protein at the level of 3.2 g/L. In this combination; the sensitivity, specificity, PPV, NPV in determining the exudative fluids were determined as 95.0%, 64.4%, 88.9% and 81.0% respectively. On the basis of certain diagnosis, the sensitivity, specificity, PPV, NPV of Light’s critera in determining the exudative fluids were determined as 96.0%, 75.0%, 92.0 %, and 85.9 % respectively.

Conclusion: In this study, the sensitivity and spesifity of pleural LDH and TP at certain cut-off values was found to be comparable with Light’s criteria in the exudate-transudate differentiation.In clinical practice, to use only pleural fluid parameters may be considered as easier and simple approach for the differentiation of exudate and transudate when the laboratory facilities are limited.