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• W1994923232 abstract "We read with interest the article by Roth et al, which appeared in the September 1990 issue of Chest.1Roth BJ O’Meara TF Cragun WH. The serum effusion-albumin gradient in the evaluation of pleural effusions.Chest. 1990; 98: 546-549Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar The serum-effusion albumin gradient of 1.2 g/dl is proposed as a diagnostic tool in differentiating exudate and transudate in patients with pleural effusions, especially following diuretic therapy. The same parameter, but at a level of 1.1 g/dl, has been found useful in the differential diagnosis of ascites in cirrhosis.2Rector WG Reynolds TB. Superiority of the serum-ascitis albumin difference over the ascites total protein concentration in separation of transudative and exudative ascites.Am J Med. 1984; 77: 83-85Abstract Full Text PDF PubMed Scopus (104) Google Scholar We prospectively studied 54 consecutive patients (36 men, 18 women, mean age 57 ± 11 years old) who were undergoing diagnostic or therapeutic thoracentesis to compare the diagnosis made using the serum-effusion albumin gradient with that using the Light et al3Light RW MacGregor I Luchsinger PC Ball WC. Pleural effusion: the diagnostic separation of transudates and exudates.Ann Intern Med. 1972; 77: 507-513Crossref PubMed Scopus (1227) Google Scholar traditional criteria. Using the Light et al criteria, 42 patients were defined as having exudates (16 malignancy, 13 tuberculosis, 9 parapneumonic, 1 systemic lupus erythamatosis (SLE), 1 rheumatoid arthritis, 1 radiation-induced, 1 Christian-Weber syndrome), and 12 as transudates (1 cirrhotic ascites, 11 congestive heart failure). The effusion protein and lactate dehydrogenase (LDH) levels, the effusion/serum protein and LDH ratios, and the serum-effusion albumin gradient of 1.2 g/dl in each group were compared using Student's unpaired t test and were all significantly different (Table 1).Table 1Pleural Fluid CharacteristicsExudative*p < 0.05.TransudativePl eff LDH level (U/ml)606 ± 14076 ± 20Pl eff protein level (g/dl)4 ± 1.21.9 ± 0.9Pl eff/ser LDH ratio4.8 ± 170.48 ± 0.4Pl eff/ser protein ratio0.65 ± 0.160.31 ± 0.13Ser-pl eff albumin gradient0.93 ± 0.621.75 ± 0.58X ± SD* p < 0.05. Open table in a new tab X ± SD Using albumin gradient cutoff value of 1.2 g/dl to indicate a transudate, 22 patients were classified as having transudates. Eleven of these patients had clinical congestive heart failure and one had cirrhotic ascitis. However, ten patients (four parapneumonic, one lymphoma, one radiation-induced, two tuberculosis, one malignancy, one SLE) were misclassified as transudative. The mean albumin gradient in these misclassified patients was 1.84 ± 0.41 (range: 1.3-2.6 g/dl). In the same group, one patient with tuberculosis and one patient with parapneumonic pleural effusion also had chronic renal failure. Diuretic treatment of patients with congestive heart failure caused significant elevation of the protein content; in some cases, a transudate might be converted into a pseudoexudate-high protein transudate.4Chetty KG. Transudative pleural effusions.Clin Chest Med. 1985; 6: 49-54Abstract Full Text PDF PubMed Google Scholar,5Chakko SC Caldwell SH Sforza PP. Treatment of congestive heart failure: its effect on pleural fluid chemistry.Chest. 1989; 95: 798-802Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar We performed thoracentesis immediately on identification of a patient with congestive heart failure before any diuretic therapy was given to rule out the possibility of pseudoexudates. Therefore, we did not observe any patient with high protein transudate. In the present study, the albumin gradient was 76 percent sensitive and 100 percent specific to indicate exudates. Light's criteria were 100 percent sensitive and 100 percent specific at identifying exudates. The difference between the sensitivities is clearly not significant using the proportion test (p < 0.09); McNemar's exact test showed a statistically significant difference between these two methods (p < 0.05). In a group of 26 patients with malignant effusions Roth et al1Roth BJ O’Meara TF Cragun WH. The serum effusion-albumin gradient in the evaluation of pleural effusions.Chest. 1990; 98: 546-549Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar were able to identify only two patients with an albumin gradient in the transudative range, and proposed the use of this parameter, partially in cases of congestive heart failure. We conclude that the serum-effusion albumin gradient is a reliable criterion for differentiating exudative from transudative effusion. We found this gradient, however, compared with Light's criteria, has a tendency to overdiagnose a transudate, and we believe its use should be limited to patients suffering from heart failure. Serum-effusion Albumin Gradient in Separation of Transudative and Exudative Pleural EffusionsCHESTVol. 105Issue 3PreviewThe results reported by Dr. Ceyhan differ from ours in two very important aspects. First, he specifically excluded patients with congestive heart failure who are on chronic diuretic therapy. These are the very patients where the albumin gradient appears to be helpful and where it appeared that the albumin gradient was more specific than the Light et al criteria (Chest 1990; 98: 546-49). Full-Text PDF" @default.
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• W1994923232 title "Serum-effusion Albumin Gradient in Separation of Transudative and Exudative Pleural Effusions" @default.
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