Significance of serum-pleural effusion albumin gradient in differentiating transudative and exudative pleural effusions in comparison to light’s criteria
Keywords:Exudate, Effusion, Pleural effusion, Transudate
Background:Approximately one million patients develop pleural effusion every year. It is a common clinical disorder and is either a manifestation or a complication of one or other respiratory or non-respiratory disorders. It leads to serious prognosis, if not diagnosed and treated properly. To calculate SEAG and Light’s criteria and to compare SEAG with Light’s criteria in analyzing pleural effusions.
Methods: A total of hundred patients were selected for the study. Pleural fluid of patients who met the inclusion and exclusion criteria were collected, when pleural fluid is being tapped for diagnostic thoracocentesis. Venous blood sample was collected along with diagnostic thoracocentesis or within 24 hours of thoracocentesis. Written informed consent was obtained from them for thoracocentesis.
Results:In our study we compared the clinical outcome with outcome as per Pleural fluid/Serum protein ratio (p value of <0.0001), pleural fluid/serum LDH (p value of <0.0001) and pleural fluid LDH (p value of <0.0001) separately and the p values were statistically significant. The sensitivity, specificity, PPV and NPV of Light’s criteria were 77.2%, 100%, 100%, 93.9% respectively. We compared Light’s criteria outcome with clinical outcome and the difference was statistically significant (p value of <0.0001). SEAG showed 100% sensitivity, 97.43% specificity, 91.6% PPV and is 91.66% and NPV is 100%. We compared the clinical outcome with SEAG and there was statistically significant difference (p value of <0.0001). We compared SEAG with Light’s criteria and the difference was statistically significant (p <0.0001). We compared Light’s plus pleural fluid protein gradient with SEAG and the difference is statistically significant (p value of <0.0001).
Conclusions:SEAG is more sensitive for classifying transudates and more specific for exudates than Light’s criteria.
Gupta KB, Aggarwal SK, Kumar S, Manchanda M. Evaluation of plasma-pleural effusion albumin gradient for differentiating between pleural transudate and exudate. Indian J Tuberculosis. 2003;50-3.
Sahn SA. The pleura. Am Rev Respir Dis. 1988;138:184-234.
Light RW. In: Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, Joseph Loscalzo, et al., editors. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw Hill; 2012. p. 2178.
Light RW, MacGregor I, Luchsinger PC, Ball WC. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77:507-13.
Hamun H, Broham U, Bohmer R, Missmahl HP. Cholesterol in pleural effusion a diagnostic aid. Chest. 1987;92:296-302.
Broaddus VC, Light RW. What is the origin of pleural transudates and exudates? Chest. 1992;102:658-9.
Pistolesi M, Miniati M, Guintini C. Pleural liquid and solute exchange. Am Rev Respir Dis. 1989;140(3):815-47.
Zinneman HH, Johnson JJ, Lyon RH. Proteins and microproteins in pleural effusions. Am Rev Respir Dis. 1957;76:247-55.
Shallenberger DW, Daniel TM. Quantitative determination of several pleural fluid proteins. Am Rev Respir Dis. 1972;106:121-2.
Broaddus VC, Staub NC. Pleural liquid and protein turnover in health and disease. Semin Respir Med. 1987;9:7-12.
Roth BJ, O’ Meara TF, Cragun WH. The serum-effusion albumin gradient in the evaluation of pleural effusion. Chest. 1990;98:546-9.
Paramjyothi K. Comparison of SEAG and ALP against Light’s criteria for distinguishing transudates from exudates. Asian J Medical Research. 2013;2(2):45-50.
Dhar MC, Chaudhary S, Basu K, Sau Tj, Pal D, K Mitra K. Significance of Serum effusion albumin gradient in the differential diagnosis of pleural effusion. Ind J Tub. 2000;18:241-5.
Das AK. A study on Significance of Serum effusion albumin gradient in the differential diagnosis of pleural effusion. Jk science. 2009;11(3):124-5.
Mangaraj M, Kumari S, Nandu R, Pattnaik MR, Mohapatra PC, et al. Pleural fluid MDA & serum – effusion albumin gradient in pleural effusion. IJCB. 2008;23;1.81-4.
Sunanda V, Shravanthi K. The diagnostic separation of transudates and exudates in pleural effusion. J Coll Med Sci Nepal. 2011;7(3):24-8.