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Table of Content - Volume 20 Issue 3 - December 2021


Comparative analysis of pleural fluid cholesterol levels against light’s criteria in differentiating exudative and transudative pleural effusions


Sandeep L Dandin1, Girish Dandagi2, Santosh Honnavar3* Girish Koraddi4


1,2Assistant Professor, 2Professor & HOD, 3Junior Resident, Department of Respiratory Medicine, Belagavi Institute of Medical Sciences, Ambedkar Road, Belagavi-590001, INDIA.

Email: honnavar.santosh@gmail.com


Abstract              Background: Pleural effusion is a very common clinical presentation encountered by a chest physician and may be a transudate or an exudate. In recent years pleural fluid cholesterol have been proposed for separation of transudates from exudates, and present study was aimed to study levels of Cholesterol levels in pleural fluids of varied etiologies. Material and Methods: Present study was single-center, prospective, comparative, parallel-group, observational study, conducted in patients age ≥ 14 years, evaluated on OPD basis and/or admitted with definite clinical diagnosis and pleural effusion evidenced by radiological imaging giving written informed consent for thoracocentesis. Results: In present study, 180 patients with pleural effusion were studied majority were from 30-40 years (22.2 %), males (70.6%), had right sided pleural effusion. According to clinical diagnosis 155 (86.1%) patients had exudative pleural fluid and 25 (13.9%) patients had transudative pleural effusion. According to one of light’s criteria (ratio of pleural fluid protein to serum protein more than 0.5 as exudative pleural effusion) 152 (84.4 %) patients had exudative and 28 (15.6 %) had transudative pleural effusion. While based on another Light’s criteria (pleural fluid LDH more than or equal to 200 IU suggestive of exudative pleural effusion). 143 (79.4 %) had exudative and remaining 37 (20.4 %) had transudative pleural effusion. Pleural fluid cholesterol > 40 mg/dl was considered as exudative pleural fluid, 149 (82.7 %) had exudative pleural effusion and 31 (17.3 %) had transudative. We compared mean values of pleural fluid protein, protein ratio, LDH and pleural fluid cholesterol between exudates and transudates, we noted highly significant difference between them (P value of < 0.001). Majority of the patients were of tubercular origin with no. of patients being 89 (49.4%) followed by synpneumonic effusion with 28(15.6%) patients and patients with malignant effusion being 24 (13.3%). The cut of value of pleural fluid cholesterol less than 40 mg/dl was highest with sensitivity of 95.8 and specificity of 93.7 with positive predictive value of 99.71 and negative predictive value of 82.34. Conclusion: Measuring pleural fluid cholesterol is simple and cost effective, it has better sensitivity, specificity and PPV in differentiating transudates and exudates, avoids simultaneous estimation of four parameters as required by Light’s criteria.

Keywords: pleural effusions, pleural fluid cholesterol, Light’s criteria, exudative, transudative.