A. Kadri ÇIRAK, Serpil TEKGÜL, Semra BİLAÇEROĞLU, Berna KÖMÜRCÜOĞLU, Seher Kurtul SÖNMEZ, Emel ÖZDEN
PLEVRAL SIVILARDA TRANSÜDA- EKSÜDA AYRIMINDA LİGHT KRİTERLERİ, PROTEİN GRADİYENTİ, ALBUMİN GRADİYENTİNİN VE KOMBİNASYONLARININ TANISAL DEĞERİ
Çalışmanın amacı; plevral efüzyonların transudaeksuda ayırımında Light kriterleri, albumin gradienti ve protein gradientinin ayrı ayrı ve kombine kullanıldığında tanısal verimliliklerini araştırmaktır. Bu amaçla, 87 plevral sıvılı olgu değerlendirildi. Eş zamanlı olarak alınan serum ve plevral sıvıda total protein, albumin, laktik dehidrogenaz (LDH) düzeyleri ölçüldü. Light kriterleri, albumin gradienti, protein gradienti, Light kriterleri + albumin gradienti ve Light kriterleri + protein gradienti hesaplamaları yapıldı. Light kriterleri, eksuda olgularının tamamını doğru sınıflandırdı ancak, transuda olgularını saptamada duyarlılığı düşük bulundu. Transuda-eksuda ayırımında Light kriterleri, albumin gradienti ve protein gradientinin sırasıyla duyarlılıkları: %100, %82.3, %90.1, özgüllükleri: %58.3, %97.2, %83.3 ve doğruluk oranları: %82.7, %88.5, %87.3 olarak saptandı. Transuda vasfında sıvısı olan 15 olgu, Light kriterlerine göre yanlış eksuda olarak nitelendirildi ve bu hastalar diüretik tedavisi almaktaydı. Klinik olarak transuda düşünülen ve diüretik tedavisi görmüş plevral sıvılı olgularda, Light kriterleri ile uyumsuz sonuç alındığında, ek olarak protein gradienti ya da albumin gradienti ile değerlendirmeyle özgüllük ve doğruluk oranlarında artış izlendi. Özgüllük ve doğruluk oranı, Light kriterleri-albumin gradienti kombine kullanımında, Light kriterleri-protein gradienti kombine kullanımına göre anlamlı olarak yüksek bulundu. Sonuç olarak, özellikle diüretik kullanan plevral sıvılı olgularda transuda-eksuda ayrımında Light kriterleriyle birlikte albumin gradientinin kullanılmasının tanıya katkıda bulunabileceği kanısına vardık.
Anahtar Kelimeler:
Plevral sıvı, ekuda, transuda, Light Kriterleri, albumin gradienti, protein gradienti
DIAGNOSTIC VALUE OF PLEURAL LIGHT'S CRITERIA, THE PROTEIN GRADIENT, AND THE ALBUMIN GRADIENT ALONE OR IN COMBINATION IN DIFFERENTIATION OF EXUDATES AND TRANSUDATES
To determine the diagnostic efficacy of Light's criteria, the albumin gradient, and the protein gradient, alone or in combination, in the differentiation of pleural transudates and exudates. Eighty-seven patients with pleural effusions, 51 (59%) of which were exudative and 36 (41%) of which were transudative, were assessed between January 2006 and February 2007. Of these patients, 71 (81.6%) were males and 16 (18.4%) were females. Total protein, albumin, and lactate dehydrogenase (LDH) levels were measured in the serum and pleural effusion samples were concurrently obtained. Calculations for Light's criteria, the albumin gradient, the protein gradient, Light's criteria and the albumin gradient, and Light's criteria and the protein gradient were performed. Light's criteria classified all of the exudates correctly; however, the sensitivity in determining transudates was low. The sensitivities of Light's criteria, the albumin gradient, and the protein gradient in the differentiation of transudates and exudates were 100%, 82.3%, and 90.1%, respectively; the corresponding specificities were 58.3%, 97.2%, and 83.3%, respectively; and the corresponding accuracies were 82.7%, 88.5%, and 87.3%, respectively. Fifteen cases of transudates were incorrectly classified as exudates by Light's criteria and were treated with diuretics. An increase in specificity and accuracy occurred by the additional assessment of the protein or albumin gradient when inconsistent results were obtained by Light's criteria in cases with pleural effusion clinically suspected to be a transudate and treated with diuretics. The specificity and accuracy were significantly higher with the combined use of Light's criteria and the albumin gradient compared to the combined use of Light's criteria and the protein gradient. The combined use of the Light's criteria and albumin gradient may contribute to differentiation of transudates and exudates in patients particularly those treated with diuretics.
Keywords:
Pleural effusions, exudate, transudate, Light criteria, albumin gradient, protein gradient,
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- 1. Light RV, MacGregor MI, Luchsingcr PC, et al. Pleural effusion: the diagnostic seperation of tansudates and exudates. Ann Intern Med 1972; 77: 507-13.
- 2. Bartter T, Santarelli R, Akers SM. Pratter MR. The evaluation of pleural effusion. Chest 1993: 104: 399-404.
- 3. Roth BJ, O'Meara TF, Cragun WH. The serum-effusion albumin gradient in the evaluation of pleural effusions. Chest 1990: 98: 546-9.
- 4. Rose F. on the compounds of albumin with metal oxides. Annalen der Physik und Chemier 1833; 28: 132-42.
- 5. Diamond D, Lau K.T, Brady S, Cleary J. "Integration of analytical measurements and wireless communications-Current issues and future strategies". Talanta, 2008. 75(3): p. 606-612.
- 6. Bergmeyer HU, Fujii H, Miwa S. Methods of Enzymatic Analysis, Pyruvate kinase assay in serum and erythrocytes. ed Bergmeyer HU. Verlag Chemie, Weinheim. 1983; 3: 496- 501.
- 7. Porcel JM, Mart›´nez-Alonso M, Cao G, et al. Biomarkers of heart failure in pleural fluid. Chest 2009;136: 671-7.
- 8. Carr DT, Power MH. Clinical of measurements of concentration of protein in pleural fluid. N Engl J Med 1958; 259: 926-7.
- 9. Romero S, Candela A, Consepcion M, Hernandez L, Trigo C, Gil J. Evaluation of different criteria for the separation of pleural transudates from exudates. Chest 1993; 104: 399-404.
- 10. Gazquez I, Porcel JM, Vives M, et al. Comparative analysis of Light criteria and other biochemical parameters for distinguishing transudates from exudates. Respir Med 1998; 92: 762-5.
- 11. Cosar D, C›rak K, Halilcolar H. Plevral efüzyonlar›n transuda-eksuda ayr›m›nda biyokimyasal parametrelerin ve yeni gelifltirilen formüllerin de¤eri. Toraks Dergisi 2005; 6(1l): 44-50.
- 12. Chakko SC, Caldwell SH, Sforza PP. Treatment of congestive heart failure: its effect on pleural fluid chemistry. Chest 1989; 95: 798-802.
- 13. Hamm H, Brohan U, Bohmer R, et al. Cholesterol in pleural effusions. A diagnostic aid. Chest 1987; 92: 296-302.
- 14. Valdes L, Pose A, Suarez J, et al. Cholesterol: A useful parameter for distinguishing between pleural exudates and transudates. Chest 1991; 99: 1097-102.
- 15. Banter T, Santarelli RS, Pratter MR. Transudate vs exudate: Genug, Chest 1996; 109: 1419-21.
- 16. Burgess LJ, Maritz FJ, Frans Taljaard JJ. Comparative analysis of the biochemical parameters used to distinguish between pleural transudates and exudates. Chest 1995; 107: 1604-9.
- 17. Metintas M, Alatas O, Alatas F, et al. Comparative analysis of biochemical parameters for differentiation of pleural exudates from transudates Light criteria, cholesterol, bilirubin, albumin gradient, alkaline phosphatase, creatine kinase, and uric acid. Clinica Chimica Acta 1997; 264: 149-62.
- 18. Romero-Candeira S, Hernandez L. The separation of transudates and exudates with particular reference to the protein gradient. Curr Opin Pulm Med 10: 294-8.
- 19. Berktas MB, Yag›z J, Mutluay NI, Berkoglu M. Plevral s›v›lar›n eksuda-transuda ay›r›m›nda serum-plevra s›v›s› protein düzey fark›n›n kullan›m›. Toraks Dergisi 2004; 5(2): 95-9.
- ISSN: 1300-4115
- Başlangıç: 1986
- Yayıncı: Ali Cangül
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