Role of pleural fluid cholesterol in differentiating transudative from exudative pleural effusion.
BACKGROUND
Pleural fluid cholesterol has been reported to be useful in distinguishing between transudative and exudative pleural effusion. However, the difference in lipid profile between tubercular and non-tubercular pleural effusion has not been studied.


METHODS
The lipid profile of pleural fluid in 50 patients with exudative (25 tubercular and 25 non-tubercular) and 25 with transudative effusion was studied. The diagnosis was based on clinical criteria and/or a positive diagnosis from another site.


RESULTS
The criteria that best identified an exudative pleural effusion were pleural fluid cholesterol > or = 60 mg/dl, pleural fluid to serum cholesterol ratio > or = 0.4, pleural fluid triglyceride > or = 40 mg/dl and pleural fluid to serum triglyceride ratio > or = 0.3. Pleural fluid cholesterol had a sensitivity of 88% and a specificity of 100% for exudates with an accuracy of 92%. Pleural fluid to serum cholesterol ratio had a sensitivity of 98% and a specificity of 84%. These results were superior to the criteria proposed by Light et al. (sensitivity 98% and specificity 80%).


CONCLUSIONS
Pleural fluid cholesterol estimation is an effective and cost-efficient method of differentiating exudative from transudative pleural effusion. The lipid profile does not help in diagnosing tubercular effusion.
Guleria
R
R
Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. randeepg@hotmail.com
Agarwal
S R
SR
Sinha
Sanjeev
S
Pande
J N
JN
Misra
Anoop
A
D000328:Adult; D002784:Cholesterol / Q000032:analysis*; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000737:chemistry*; D012680:Sensitivity and Specificity
D002784:Cholesterol