title: Significance of Total Protein, Albumin, Globulin, Serum Effusion Albumin Gradient and LDH in the Differential Diagnosis of Pleural Effusion Secondary to Tuberculosis and Cancer.
abstract: BACKGROUND
  Lung cancer and Pulmonary tuberculosis are two major public health problems associated with significant morbidity and mortality worldwide particularly in low and middle income countries like India. Wrong diagnosis of lung cancer cases as pulmonary tuberculosis in primary health care system delays the onset of anti-cancer chemotherapy as well as initiation of DOTS thus increasing complication and mortality rate in malignancy patients. In this context easy, cost effective diagnostic tool at primary level must be the priority and need of hour.
  
  
  OBJECTIVE
  To study and evaluate any significance of biochemical parameters (total protein, albumin, globulin, serum effusion albumin gradient, LDH) in serum and pleural effusion secondary to tuberculosis and lung cancer.
  
  
  METHODS
  A case control study was carried out on patients attending OPD and IPD, Department of Pulmonary Medicine, RMCH. Hundred cases of Tuberculosis effusion, 50 cases of Malignant effusion and 100 age and sex matched apparently healthy controls were taken for correlation of biochemical parameters (total protein, albumin, globulin, serum effusion albumin gradient, LDH) and statistically evaluated to find any significance between tuberculosis, lung cancer and control group. Blood and pleural fluid samples were collected and then subjected to assessment of parameters (total protein, albumin, LDH) by using EM360 Autoanalyser and kits were supplied by Transasia diagnostics. Globulin and Serum Effusion Albumin Gradient (SEAG) was calculated mathematically.
  
  
  METHODS
  Data is presented as mean ± SD. Comparison of serum and pleural fluid levels (of taken parameters) were done in TB, Lung Cancer and Control groups by ANOVA and students t-test. The p-value <0.05 were considered as statistically significant.
  
  
  RESULTS
  We found serum-total protein, albumin, globulin to be significantly higher in TB group than lung cancer group but serum LDH was higher in lung cancer group (in all parameters p=<0.0001). Pleural Fluid-total protein, albumin, globulin was again significantly higher in TB group than lung cancer group and LDH was higher in lung cancer group (p=<0.0001). SEAG is also significantly higher in TB group than lung cancer group (p=<0.002).
  
  
  CONCLUSIONS
  The results suggests early quantization of these parameters can differentiate pulmonary tuberculosis from lung cancer and thus can decrease the mortality rate of lung cancer cases though more extensive study with increased sample size may provide more insights.
authors.affiliation: Assistant Professor and Research Fellow, Department of Biochemistry, Rohilkhand Medical College and Hospital , Bareilly, Uttar Pradesh, India .
authors.forename: Sumeru
authors.initials: S
authors.lastname: Samanta
authors.affiliation: Associate Professor and Guide, Department of Biochemistry, Geetanjali Medical College and Hospital, Geetanjali University , Udaipur, Uttar Pradesh, India .
authors.forename: Ashish
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Professor and Head, Co-Guide, Department of Biochemistry, Rohilkhand Medical College and Hospital , Bareilly, Uttar Pradesh, India .
authors.forename: Biswajit
authors.initials: B
authors.lastname: Das
authors.affiliation: Associate Professor, Department of Biochemistry, Rohilkhand Medical College and Hospital , Bareilly, Uttar Pradesh, India .
authors.forename: Ayaz K
authors.initials: AK
authors.lastname: Mallick
authors.affiliation: Associate Professor, Department of Pulmonary Medicine, Rohilkhand Medical College and Hospital , Bareilly, Uttar Pradesh, India .
authors.forename: Amit
authors.initials: A
authors.lastname: Kumar
keywords: Lung cancer; Mortality rate; Pulmonary tuberculosis