European Journal of Molecular & Clinical Medicine

Abstract

Background: Pleural effusion is a common disorder. Based on the underlying pathology, the effusions are classified into transudates an exudates. Presently, Light’s criteria [3] are used to distinguish between transudates and exudates. But many pleural effusions have been misclassified as transudates or as exudates using Light’s criteria. The present study was done to evaluate the diagnostic accuracies of serum-effusion albumin gradient (SEAG) and pleural fluid protein thiols in differentiating pleural fluids exudates from transudates.
Material & Methods:
This was a prospective study conducted in a tertiary care hospital in. The study was conducted from (March 2019 to Sep 2020) Rajshree Medical Research Institute, Bareilly, Lucknow. Patients with pleural effusion due to various diseases were included in this study. Pleural effusion and serum samples were collected from all patients. Thoracocentesis was performed to collect pleural effusion, while serum was collected from the venous blood using a 5 mL syringe. Albumin, Total Proteins, Lactate dehydrogenase and Protein thiols were measured in both Serum and pleural fluid.
Results & Discussion:
There was a significant difference in the level of serum and pleral fluid parameters of total protein, albumin, LDH, thiols between transudates and exudates, which was statistically significant (P<0.001). The results presented in this study demonstrate that the concentration of protein thiol in serum was markedly reduced in patients with exudates compared to transudates. The present study has shown that even though taking into account the light’s criteria and SEAG in differentiating exudates and transudates. The greater differential value was found with a combination of SEAG and pleural fluid protein thiols, which correctly classified 92.31% of transudates and 93.34% of exudates with sensitivity and specificity of 92.31% and 83.34% and 93.34% and 92.31% respectively.
Conclusion: The present study shows that measurement of serum & pleural fluid protein thiols in patients with pleural effusion of diverse etiology proved to be better marker for the differentiation of exudates and transudates, as this method provided a high sensitivity and specificity for characterization of effusion as an exudates and transudates compared to light’s criteria. This explains the different pathophysiology behind the production of exudates and transudates. However to overcome the limitation of misclassification by using light’s criteria, we advocate measurement of serum and pleural fluid protein thiols along with SEAG could be better alternative in differentiation of exudates and transudates in clinical practice