New criteria for the differentiation between transudates and exudates.
OBJECTIVE
To investigate whether cholesterol and lactate dehydrogenase (LDH) measurements in fluids are more sensitive and specific markers for differentiating between exudates and transudates, as confirmed clinically, than the measurement of fluid total protein concentrations alone.


METHODS
Serum, pleural fluid, and ascitic fluid from 61 unselected patients were analysed retrospectively for LDH, cholesterol, and total protein. Clinical classification of transudate or exudate was reached independently by reviewing clinical details and laboratory data.


RESULTS
Of 54 samples (40 pleural fluid and 14 ascitic fluid), 30 were classified clinically as exudates and 24 as transudates. Fluid LDH and fluid to serum protein ratio measurements were equally good at differentiating between exudates and transudates, with a sensitivity of 90%, a specificity of 79%, a positive predictive value (PPV) of 84%, and a negative predictive value (NPV) of 86%. A combination of these parameters improved sensitivity to 100% and NPV to 100%, but lowered the specificity to 71% and PPV to 81%. This combination achieved a higher efficiency than Light's criteria.


CONCLUSIONS
Routine measurement of fluid LDH values and the calculation of fluid to serum total protein ratios will aid in differentiating exudates from transudates.
Paramothayan
N S
NS
Department of Respiratory Medicine, St. Helier Hospital, Carshalton, Surrey SM5 1AA, UK.
Barron
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000737:chemistry*; D015415:Biomarkers / Q000032:analysis; D001798:Blood Proteins / Q000032:analysis; D002784:Cholesterol / Q000032:analysis; D005122:Exudates and Transudates / Q000737:chemistry*; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000737:chemistry*; D011237:Predictive Value of Tests; D011506:Proteins / Q000032:analysis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D015415:Biomarkers; D001798:Blood Proteins; D011506:Proteins; D002784:Cholesterol; D007770:L-Lactate Dehydrogenase