Role of Pleural Fluid Cholesterol in DifferentiatingExudative and Transudative Pleural Effusion

Ragasudha, P (2020) Role of Pleural Fluid Cholesterol in DifferentiatingExudative and Transudative Pleural Effusion. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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INTRODUCTION: Light et 1972 found criteria to have sensitivity and specificity of 99% and 98% respectively for differentiating exudative and transudative pleural effusions. But the other studies only reproduce specificities of 70-86% using Light’s criteria. Pleural fluid cholesterol can be used to classify exudative and transudative pleural effusion. AIM OF THE STUDY: To assess the role of pleural fluid cholesterol in differentiating exudative and transudative pleural effusion. MATERIALS AND METHODS: It is a cross sectional study in Tirunelveli Medical College from January 2018 to July 2019. After complete evaluaion, diagnostic thorcentesis was performed and all pleural fluid samples were tested for cell count, cytology, protein, sugar, LDH, cholesterol, ADA. Routine blood investigations were sent for sugar, urea, creatinine, LDH, protein, HIV testing. sputum AFB, CBNAAT, CT chest, bronchoscopy were also done. RESULTS: Out of 100 patients 27 with transudates and 73 with exudates were considered according to clinical diagnosis. The most frequent cause of exudative pleural effusion is tuberculosis followed by malignancy and parapneumonic effusion with 48%, 15%, and 10% respectively. Transudative pleural effusion comprises only 27%. The mean pleural fluid protein was 3.46 g/dl in transudative effusion. In exudative effusion 4.91gm/dl. The mean pleural fluid LDH in transudative effusion was 230.48IU/L. In exudative effusion 970.30 IU/L. The mean pleural fluid cholesterol in transudative effusion was 24.44mg/dl and in exudative effusion 83.92mg/dl. The protein ratio identified exudates with a sensitivity of 94.52% and specificity of 14.81% .The pleural fluid to serum LDH ratio has a sensitivity of 94.52% and specificity of 25.93%. The Light’s criteria showed 98.63% sensitivity and 18.52% specificity. Pleural fluid cholesterol has a sensitivity of 100% and specificity of 92.59% for diagnosis of exudates with a PPV of 97.33% in this study. CONCLUSION: In our study the pleural fluid cholesterol > 45mg/dl has a better sensitivity [100%], specificity [92.59%] and positive predictive value [97.33%] in differentiating exudates and transudates than the parameters of Light’s criteria. It avoids the serum protein, serum LDH, pleural fluid protein and pleural fluid LDH.

Item Type: Thesis (Masters)
Additional Information: 201727202
Uncontrolled Keywords: Cholesterol, Light’s criteria, Exudate, Transudate.
Subjects: MEDICAL > Tuberculosis and Respiratory Medicine
Depositing User: Subramani R
Date Deposited: 04 Feb 2021 16:28
Last Modified: 04 Feb 2021 16:28

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