title: Role of pleural fluid cholesterol in differentiating transudative from exudative pleural effusion.
abstract: 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.
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. randeepg@hotmail.com
authors.forename: R
authors.initials: R
authors.lastname: Guleria
authors.forename: S R
authors.initials: SR
authors.lastname: Agarwal
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sinha
authors.forename: J N
authors.initials: JN
authors.lastname: Pande
authors.forename: Anoop
authors.initials: A
authors.lastname: Misra
mesh_terms: 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
chemical_list: D002784:Cholesterol