The Evaluation of the Light Parameters and Pleural Fluid Cholesterol to Determine the Differences Between Exudative and Transudative Pleural Discharge

Year : 2024 | Volume :14 | Issue : 03 | Page : 32-37
By

Tshetiz Dahal,

Aegis Budhachettri,

Sujan Bohara,

  1. General Physician, Department of Medicine, Lugansk State Medical University, , Ukraine
  2. SHO/PG (Public Health), University of Chester, Parkgate Rd, Chester, , England
  3. General Physician, KIST Medical College and Teaching Hospital, , Nepal

Abstract

Background: Pleural effusion occurs when an imbalance between pleural fluid production and absorption leads to the accumulation of excess fluid in the pleural cavity. Pleural effusions are commonly classified into two types: transudative or exudative, depending on the underlying mechanism of fluid formation. While transudates typically result from systemic factors like heart failure or liver cirrhosis, exudates are usually caused by local factors such as infection, malignancy, or inflammation. Differentiating between transudates and exudates is essential for selecting the correct treatment strategy. Light’s criteria, which are based on pleural fluid and serum protein and lactate dehydrogenase (LDH) levels, are frequently used to differentiate between the two. However, these criteria have limitations and often require additional tests to accurately diagnose the etiology. Recently, pleural fluid cholesterol analysis has emerged as a reliable diagnostic tool that can effectively differentiate exudative effusions from transudative ones, potentially reducing the need for multiple tests and invasive procedures.
Materials and Methods: This prospective study involved 80 patients with diagnosed pleural effusion. All effusions were categorized as either transudative or exudative based on their clinical presentation and etiological analysis. Light’s criteria were applied for the initial classification, and pleural fluid cholesterol levels were measured for each case. The diagnostic performance of pleural fluid cholesterol in identifying exudative effusions was evaluated by calculating its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal pleural fluid cholesterol threshold for differentiating exudates.
Results: Pleural fluid cholesterol levels demonstrated a high degree of accuracy in identifying exudative effusions, with a sensitivity of 97.84% and a precision of 98.12% (P<0.0001). The negative predictive value was found to be 93.61%, and the positive predictive value was 98.89%. ROC curve analysis yielded an area under the curve (AUC) of 0.857, with a pleural fluid cholesterol cut-off of 52 mg/dL being the most effective threshold for differentiation. These findings suggest that pleural fluid cholesterol is a highly reliable marker for diagnosing exudative effusions, with performance metrics superior to those of Light's criteria.
Conclusion: Pleural fluid cholesterol analysis offers a more accurate and practical method for identifying exudative pleural effusions compared to Light’s criteria. The high sensitivity and specificity of cholesterol testing reduce the need for multiple blood tests and invasive procedures, thereby streamlining the diagnostic process. Incorporating cholesterol measurement into routine clinical practice could greatly improve the diagnosis and treatment of pleural effusions, especially in situations where the cause is unclear. Further studies with larger sample sizes are recommended to validate these findings and assess their applicability in diverse patient populations.=

Keywords: Pulmonary, Cholesterol, Transudative Effusion, exudative effusion, pleural effusion, Pleural fluid.

[This article belongs to Research & Reviews : A Journal of Life Sciences (rrjols)]

How to cite this article:
Tshetiz Dahal, Aegis Budhachettri, Sujan Bohara. The Evaluation of the Light Parameters and Pleural Fluid Cholesterol to Determine the Differences Between Exudative and Transudative Pleural Discharge. Research & Reviews : A Journal of Life Sciences. 2024; 14(03):32-37.
How to cite this URL:
Tshetiz Dahal, Aegis Budhachettri, Sujan Bohara. The Evaluation of the Light Parameters and Pleural Fluid Cholesterol to Determine the Differences Between Exudative and Transudative Pleural Discharge. Research & Reviews : A Journal of Life Sciences. 2024; 14(03):32-37. Available from: https://journals.stmjournals.com/rrjols/article=2024/view=171789


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Regular Issue Subscription Original Research
Volume 14
Issue 03
Received August 28, 2024
Accepted September 11, 2024
Published September 12, 2024
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