title: Can cholesterol be used to distinguish pleural exudates from transudates? evidence from a bivariate meta-analysis.
abstract: BACKGROUND
  Many studies have investigated whether pleural cholesterol levels can aid in diagnosis of pleural exudates, and the results have varied considerably. To gain a more reliable answer to this question, we meta-analyzed the literature on using pleural cholesterol or the ratio of cholesterol in pleural fluid to cholesterol in serum (P/S cholesterol ratio) as diagnostic tests to help identify pleural exudates.
  
  
  METHODS
  Literature databases were systematically searched for studies examining accuracy of pleural cholesterol or P/S cholesterol ratios for diagnosing pleural exudates. Data on sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR) were pooled using bivariate-effects models. Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were used to summarize overall test performance.
  
  
  RESULTS
  Our meta-analysis included up to 20 studies involving 3,496 subjects. Summary estimates for pleural cholesterol in the diagnosis of pleural exudates were as follows: sensitivity, 0.88 (95%CI 0.84 to 0.92); specificity, 0.96 (95% CI 0.92 to 0.98); PLR, 20.31 (95% CI 11.21 to 36.78); NLR, 0.12 (95% CI 0.09 to 0.17); DOR, 167.06 (95% CI 76.79 to 363.95); and AUC 0.97 (95% CI 0.95 to 0.98). The corresponding summary performance estimates for using the P/S cholesterol ratio were as follows: sensitivity, 0.94 (95% CI 0.92 to 0.96); specificity, 0.87 (95% CI 0.83 to 0.91); PLR 7.46 (95% CI, 5.47 to 10.19); NLR, 0.07 (95% CI 0.05 to 0.10); DOR, 107.74 (95% CI 60.91 to 190.60); and AUC 0.97 (95% CI 0.95 to 0.98).
  
  
  CONCLUSIONS
  Both pleural cholesterol level and the P/S cholesterol ratio are helpful for the diagnosis of pleural exudates. Nevertheless, the results of pleural cholesterol assays should be interpreted in parallel with the results of traditional tests and clinical information.
authors.forename: Yongchun
authors.initials: Y
authors.lastname: Shen
authors.forename: Hong
authors.initials: H
authors.lastname: Zhu
authors.forename: Chun
authors.initials: C
authors.lastname: Wan
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.forename: Ting
authors.initials: T
authors.lastname: Yang
authors.affiliation: Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China. wenfuqiang.scu@gmail.com.
authors.forename: Fuqiang
authors.initials: F
authors.lastname: Wen
mesh_terms: D019540:Area Under Curve; D002784:Cholesterol / Q000032:analysis* / Q000097:blood*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D010996:Pleural Effusion / Q000378:metabolism*; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D002784:Cholesterol
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