Role of biochemical tests in the diagnosis of large pericardial effusions.
OBJECTIVE
To determine the biochemical characteristics of large pericardial effusions in various disease states, and to assess their utility as diagnostic tools.


METHODS
An academic university hospital in the Western Cape, South Africa.


METHODS
Consecutive, prospective case series.


METHODS
One hundred ten hospital patients > 12 years old, who presented to the echocardiography department with large pericardial effusions, and 12 control subjects who underwent open-heart surgery (coronary artery bypass graft or aortic valve replacement).


METHODS
Fluid was sent for examination of biochemistry, adenosine deaminase, microbiology, hematology, and cytology. The etiology of each pericardial fluid sample was established using predetermined criteria.


RESULTS
The biochemistry of pericardial exudates differed significantly from pericardial transudates. Light' s criteria (whereby an exudate is defined as having one or more of the following: pleural fluid/serum protein ratio > 0.5; pleural fluid/serum lactate dehydrogenase [LDH] ratio > 0.6; and/or pleural fluid LDH level > 200 U/L) were applied to pericardial fluids and demonstrated to be the most reliable diagnostic tool for identifying pericardial exudates. The corresponding sensitivity was 98%.


CONCLUSIONS
Although laboratory tests are a useful guideline when assessing the etiology and pathophysiology of pericardial effusions, the majority of large, clinically significant pericardial effusions result from exudative causes.
Burgess
Lesley J
LJ
Department of Chemical Pathology, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa. treades@iafrica.com
Reuter
Helmuth
H
Taljaard
J J Frans
JJ
Doubell
Anton F
AF
D001663:Bilirubin / Q000032:analysis; D002784:Cholesterol / Q000032:analysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000378:metabolism; D011446:Prospective Studies
D002784:Cholesterol; D007770:L-Lactate Dehydrogenase; D001663:Bilirubin