Ülkü AKA AKTÜRK, Dilek ERNAM, Nagihan DURMUŞ KOÇAK, Makbule Özlem AKBAY

EKSÜDA TRANSÜDA AYIRIMI PLEVRAL SIVI STANDART BİYOKİMYASAL PARAMETRELERİN ÖLÇÜMÜ İLE MÜMKÜN MÜDÜR?

Amaç: Plevral sıvılar sık karşılaştığımız tanısal ve klinik bir problemdir. Tanı aşamasında ilk basamak eksuda transüda ayırımının yapılmasıdır.Bu çalışmada amacımız transüda eksüda ayırımında sadece plevral mayide bakılan biokimyasal parametrelerin kullanılabilirliğini değerlendirmektir. Yöntem ve Gereç: Hastane kayıtlarından 1 Mayıs 2013-1 Mart 2015 tarihleri arasında plevral sıvı analizi yapılan hastaların verilerine ulaşıldı. İleri tetkik ve invaziv işlemler sonucu son tanısı konanlar çalışmaya dahil edildi. Son tanılar esas alınarak eksuda transüda ayırımında plevral LDH total protein ve ADA için cut-off değerler belirlendi, sensitivite ve spesifiteleri hesaplandı.Light kriterleri ile karşılaştırıldı. Bulgular: Toplamda hastane kayıtlarından dahil edilme kriterlerine uyan 1433 hasta çalışmaya dahil edildi. Son tanıları esasa alındığında hastaların %75.1'i eksuda, %24.9'u ise transuda vasfında sıvıya sahipti. Plevral sıvı LDH için 171 IU/L ve protein için 3.2 g/L cut-off değer olarak ele alındığında eksuda vasfındaki sıvıları ayırt etmede sensitivite, spesifite, PPD ve NPD sırası ile 95.0%, 64.4%,88.9% and 81.0% olarak saptandı. Öte yandan Light kriterleri için eksuda tarnsüda ayırımında sensitivite, spesifite, PPD ve NPD sırası ile %96.0, %75.0, %92.0 and %85.9 olarak tespit edildi. Sonuç: Bu çalışmada eksuda transuda ayırımında belirli cut-off değerlerinde plevral LDH ve protein kombinasyonunun sensitivite ve spesifite değerlerinin Light kriterleri ile karşılaştırılabilir olduğu görülmüştür. Klinik pratikte eksuda transüda ayırımında laboratuar imkanlarının kısıtlı olduğu durumlarda daha kolay ve ucuz olması nedeniyle sadece plevral sıvı parametrelerinin kullanımı akılda tutulabilir.

Anahtar Kelimeler:

Eksuda, transüda, plevral sıvı

IS IT POSSIBLE TO DIFFERENTIATE BETWEEN EXUDATE AND TRANSUDATE ONLY BY STANDARD BIOCHEMICAL PARAMETERS IN PLEURAL FLUID?

Aim: The pleural fluid often presents diagnostic and clinical problems.The first step in the examination of pleural effusion is to differentiate between transudate and exudate.The aim of this study was to evaluate the clinical utility of standard pleural fluid parameters in the differentiation of transudative and exudative pleural effusion in tuberculosis endemic country. Material and methods: The records of patients who had pleural fluid analysis between 1 May 2013 and 1 March 2015 were electronically obtained.On the basis of the classification according to certain diagnosis after the careful evaluation of clinical data and diagnostic procedures, the cut-off values of pleural lactate dehydrogenease(LDH), total protein(TP) and adenosine deaminase(ADA) were determined. The sensitivity and spesifity of these parameters used in exudate-transudate differentiation were calculated and compared with Lights criteria. Results: Totally 1433 precisely diagnosed patients with appropriate criteria were included in the study. On the basis of certain diagnosis 75.1% of them were exudate and 24.9% of them were transudate. When 171 IU/L was taken as the cut-off value of pleural LDH, the rates of sensitivity, specificity were 85% and over, while 3.2 g/L was taken as the cut-off value of the pleural total protein, the rates of sensitivity and spesifity were between 72 % - 85 %. The most appropriate combination parameters for clinical use were those of LDH at the level of 171 IU/L and total protein at the level of 3.2 g/L. In this combination; the sensitivity, specificity, PPV, NPV in determining the exudative fluids were determined as 95.0%, 64.4%, 88.9% and 81.0% respectively. On the basis of certain diagnosis, the sensitivity, specificity, PPV, NPV of Lights critera in determining the exudative fluids were determined as 96.0%, 75.0%, 92.0 %, and 85.9 % respectively. Conclusion: In this study, the sensitivity and spesifity of pleural LDH and TP at certain cut-off values was found to be comparable with Lights criteria in the exudate-transudate differentiation.In clinical practice, to use only pleural fluid parameters may be considered as easier and simple approach for the differentiation of exudate and transudate when the laboratory facilities are limited.

Keywords:

Exudative, transudative, pleural fluid,

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