Abstract
BackgroundMany studies have investigated whether pleural cholesterol levels can aid in diagnosis of pleural exudates, and the results have varied considerably. To gain a more reliable answer to this question, we meta-analyzed the literature on using pleural cholesterol or the ratio of cholesterol in pleural fluid to cholesterol in serum (P/S cholesterol ratio) as diagnostic tests to help identify pleural exudates.MethodsLiterature databases were systematically searched for studies examining accuracy of pleural cholesterol or P/S cholesterol ratios for diagnosing pleural exudates. Data on sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR) were pooled using bivariate-effects models. Summary receiver operating characteristic (SROC) curves and area under the curve (AUC) were used to summarize overall test performance.ResultsOur meta-analysis included up to 20 studies involving 3,496 subjects. Summary estimates for pleural cholesterol in the diagnosis of pleural exudates were as follows: sensitivity, 0.88 (95%CI 0.84 to 0.92); specificity, 0.96 (95% CI 0.92 to 0.98); PLR, 20.31 (95% CI 11.21 to 36.78); NLR, 0.12 (95% CI 0.09 to 0.17); DOR, 167.06 (95% CI 76.79 to 363.95); and AUC 0.97 (95% CI 0.95 to 0.98). The corresponding summary performance estimates for using the P/S cholesterol ratio were as follows: sensitivity, 0.94 (95% CI 0.92 to 0.96); specificity, 0.87 (95% CI 0.83 to 0.91); PLR 7.46 (95% CI, 5.47 to 10.19); NLR, 0.07 (95% CI 0.05 to 0.10); DOR, 107.74 (95% CI 60.91 to 190.60); and AUC 0.97 (95% CI 0.95 to 0.98).ConclusionsBoth pleural cholesterol level and the P/S cholesterol ratio are helpful for the diagnosis of pleural exudates. Nevertheless, the results of pleural cholesterol assays should be interpreted in parallel with the results of traditional tests and clinical information.
Highlights
Many studies have investigated whether pleural cholesterol levels can aid in diagnosis of pleural exudates, and the results have varied considerably
The corresponding summary performance estimates for using the P/S cholesterol ratio were as follows: sensitivity, 0.94; specificity, 0.87; positive likelihood ratios (PLR) 7.46; negative likelihood ratios (NLR), 0.07; diagnostic odds ratio (DOR), 107.74; and area under the curve (AUC) 0.97
Both pleural cholesterol level and the P/S cholesterol ratio are helpful for the diagnosis of pleural exudates
Summary
Many studies have investigated whether pleural cholesterol levels can aid in diagnosis of pleural exudates, and the results have varied considerably. Pleural effusion often develops in patients with thoracic or systemic diseases [1]. Such effusion has traditionally been classified as transudate or exudate based on the etiology and underlying pathology, and differentiating the two types of pleural effusion is critical for guiding treatment [2,3]. Transudates are usually taken as a sign of underlying congestive heart failure, cirrhosis, or nephrosis, which becomes the focus of treatment. Full list of author information is available at the end of the article to the underlying congestive heart failure, cirrhosis, or nephrosis. The criteria most widely used to differentiate exudates and transudates in patients with pleural effusions are Exudates are usually taken as a sign of, inflammatory disorders or malignancy, leading to more extensive diagnostic procedures [4,5].
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