The Usefulness of Pleural Lactate Measurement for Differentiating Transudate and Exudate

Öz

Our study aimed to evaluate pleural lactate levels, to identify the reliability and validity of determining pleural fluid quality in patients with pleural effusion.This is a prospective, observational study conducted on patients who were admitted to a university hospital between July 1, 2017, and January 31, 2018, and diagnosed with pleural effusion. Pleural fluid classification into transudates and exudates was made according to Light’s criteria. The study group consisted of a total of 169 patients with pleural effusion, [99 (58.6%) male and aging 18-93 years (mean ± SD, 64.6 ± 16.1 years)]. Forty-four (26%) of the patients were evaluated as exudate and 125 (74%) as transudate. The median value of lactate was 3.20 mmol/L (min-max: 0.90-14.3) in exudate patients and 1.85 mmol/L (min-max: 0.90-4.70) in transudate patients, and a significant difference was detected in the comparison of both (z: 5.894; p<0.001). There was a positive correlation between pleural lactate levels and pleural LDH, pleural LDH/serum LDH and pleural protein/serum protein ratios. The cut-off value of the pleural fluid lactate level was determined to be 2.0 for the highest sensitivity and specificity (sensitivity: 85%, specificity: 64%; AUC: 0.799). Measurement of lactate levels in pleural fluid can be useful for the differentiation of transudate and exudate fluid. Moreover, detection of lactate levels in a very short period may provide a more useful screening tool compared to other strategies.

Anahtar Kelimeler

• transuda
• eksuda
• plevral laktat

Transuda ve Eksüdayı Ayırt Etmek için Plevral Laktat Ölçümünün Kullanılabilirliği

Öz

Çalışmamız, plevral efüzyonlu hastalarda transüda ve eksüdayı ayırt etmenin güvenilirliğini ve geçerliliğini belirleyerek plevral laktat düzeylerini değerlendirmeyi amaçladı.1 Temmuz 2017 ile 31 Ocak 2018 tarihleri arasında bir üniversite hastanesine başvuran ve plevral efüzyon tanısı alan hastalar üzerinde yapılan prospektif, gözlemsel bir çalışmadır. Transüda ve eksüda plevral sıvı sınıflandırması Light kriterlerine göre yapılmıştır. Çalışma grubu pevral effüzyonlu toplam 169 hastadan oluştu [99 (% 58.6) erkek ve 18-93 yaş arası (ortalama ± SS, 64.6 ± 16.1 yıl)]. Hastaların 44'ü (% 26) eksüda ve 125'i transüda olarak değerlendirildi. Laktatın ortanca değeri eksüda hastalarda 3.20 mmol / L (min-maks: 0.90-14.3) ve transüda hastalarda 1.85 mmol / L (min-maks: 0.90-4.70) idi ve her ikisinin karşılaştırılmasında anlamlı farklılık saptandı. (z: 5.894; p <0.001). Plevral laktat seviyeleri ile plevral LDH, plevral LDH / serum LDH ve plevral protein / serum protein oranları arasında pozitif bir korelasyon tespit edildi. En yüksek duyarlılık ve özgüllük için plevral sıvı laktat düzeyinin kestirim değeri 2.0 olarak belirlendi (duyarlılık:% 85, özgüllük:% 64, AUC: 0.799). Plevral sıvıda laktat seviyelerinin ölçümü, transüda ve eksüda sıvısının ayrımı için yararlı olabilir. Ayrıca laktat seviyesinin çok kısa sürede tespiti diğer stratejilere göre daha kullanışlı bir tarama aracı olarak kullanılabilir.

Anahtar Kelimeler

• pleural
• lactate
• trasudate
• exudate

Kaynakça

1. Cohen, M and S A Sahn, Resolution of pleural effusions. Chest, 2001. 119: 1547. 2. Yu, H. Management of pleural effusion, empyema, and lung abscess. in Seminars in interventional radiology. 2011. Thieme Medical Publishers. 3. Light, R W, J T Rogers, J P Moyers, Y C Lee, R M Rodriguez, W C Alford, Jr., et al., Prevalence and clinical course of pleural effusions at 30 days after coronary artery and cardiac surgery. Am J Respir Crit Care Med, 2002. 166: 1567-71. 4. M, M, Epidemiology of pleural effusion. Eur Respir Mon, 2002. 22: 146-156. 5. Valdes, L, D Alvarez, J M Valle, A Pose, and E San Jose, The etiology of pleural effusions in an area with high incidence of tuberculosis. Chest, 1996. 109: 158-162. 6. Anchinmane, V T and G V Puranik, The Diagnostic Separation of Transudates and Exudates in Ascitic Fluid and Pleural Fluid. Bombay Hospital Journal, 2011. 53: 166. 7. Light, R W, M I Macgregor, P C Luchsinger, and W C Ball, Pleural effusions: the diagnostic separation of transudates and exudates. Annals of internal medicine, 1972. 77: 507-513. 8. Mental health of older adults. 2017 16 March 2018]; Available from: http://www.who.int/en/news-room/fact-sheets/detail/mental-health-of-older-adults. 9. Bonita, R, R Beaglehole, and T Kjellström 2nd, Basic epidemiology 2nd edition, in WHO, Geneva. 2006. 10. Sahn, S A and J E Heffner, Pleural fluid analysis, in Textbook of pleural diseases. 2008. p. 209-226. 11. Romero-Candeira, S, L Hernández, S Romero-Brufao, D Orts, C Fernández, and C Martín, Is it meaningful to use biochemical parameters to discriminate between transudative and exudative pleural effusions? Chest, 2002. 122: 1524-1529. 12. Yang, W, B Zhang, and Z M Zhang, Infectious pleural effusion status and treatment progress. J Thorac Dis, 2017. 9: 4690-4699. 13. Kim, H H, J H Chung, D M Kim, N R Yun, J Lee, Y E Kwon, et al., The clinical characteristics of pleural effusion in scrub typhus. BMC Infect Dis, 2016. 16: 278. 14. Villena, V, A E López, J Echave-Sustaeta, C M Alvarez, and P E Martín, Prospective study of 1,000 consecutive patients with pleural effusion. Etiology of the effusion and characteristics of the patients. Archivos de bronconeumologia, 2002. 38: 21-26. 15. Yeo, C D, J W Kim, M R Cho, J Y Kang, S J Kim, Y K Kim, et al., Pleural fluid pentraxin-3 for the differential diagnosis of pleural effusions. Tuberculosis and respiratory diseases, 2013. 75: 244-249. 16. Aydin, Y, A Turkyilmaz, Y S Intepe, and A Eroglu, Malignant pleural effusions: appropriate treatment approaches. Eurasian J Med, 2009. 41: 186-93. 17. Maranhão, B H F, C T d Silva Junior, A M d S Chibante, and G P Cardoso, Determination of total proteins and lactate dehydrogenase for the diagnosis of pleural transudates and exudates: redefining the classical criterion with a new statistical approach. Jornal Brasileiro de Pneumologia, 2010. 36: 468-474. 18. Burgess, L J, F J Maritz, and J F Taljaard, Comparative analysis of the biochemical parameters used to distinguish between pleural transudates and exudates. Chest, 1995. 107: 1604-1609. 19. 20. 21. Bonita, R, R Beaglehole, and T Kjellström. Basic Epidemiology. [cited 2018 25 March]; 2nd Edition:[Available from: http://apps.who.int/iris/bitstream/handle/10665/43541/9241547073_eng.pdf;jsessionid=F5E88F4EB3C9F547AEA0C00ABD983046?sequence=1. 20. Baratloo, A, M Hosseini, A Negida, and G El Ashal, Part 1: simple definition and calculation of accuracy, sensitivity and specificity. 2015.