“Efficacy of Total Pleural Fluid Bilirubin And Ratio to Serum Levels, Pleural Fluid Cholesterol And Total Protein Level in Diagnosing Pleural Effusion Exudates And Transudates And Its Correlation with light’s Criteria”

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INTRODUCTION: Pleural effusion is a very common clinical presentation of diseases. A correct diagnosis of the underlying disease is essential for the management of pleural effusion. Therefore, the first step is to classify them as transudates or exudates. Light’s criteria is the most commonly used method. It was found that even Light’s criteria misclassified a large number of effusions, 25% of transudates as exudates. Hence, there is a need to investigate into new parameters which will prove to be superior or supportive to the present available array of tests. Hence, this study is being done to evaluate the Efficacy of Total Pleural fluid Bilirubin and its ratio to serum Bilirubin levels, Pleural fluid Cholesterol and Pleural fluid total Protein level in classifying the Pleural Effusion as Exudates and Transudates and its correlation with Light’s criteria. AIMS AND OBJECTIVES: To evaluate the usefulness of Total Pleural fluid Bilirubin and its ratio to serum Bilirubin levels, Pleural fluid Cholesterol and Pleural fluid Total Protein level in classifying pleural effusions as exudates and transudates. MATERIALS AND METHODS: STUDY POPULATION: This study is to be conducted among 50 patients with pleural Effusion, attending the Department of Medicine & Department of Thoracic Medicine in Govt. Rajaji Hospital, Madurai STUDY PROTOCOL: 1. Patients with clinical and radiological evidence of pleural effusion are to be included in the study.Then they are classified in to exudates and transudates on the basis of the clinical, radiological and biochemical evaluation. 2. Pleural fluid bilirubin & Serum Bilirubin, Pleural fluid cholesterol, Pleural fluid total protein are estimated and the patients are classified in to exudates and transudates. Then the patients are classified in to exudates and transudates on the basis of Light’s criteria. 3. Now the classification of exudates and transudates done on the basis of Total Pleural fluid bilirubin and its ratio to serum bilirubin, Pleural fluid cholesterol, Pleural fluid Total protein are compared with results of the classification of exudates and transudates done on the basis of Light’s criteria. 4. Sensitivity, specificity, Positive predictive value, negative predictive value, diagnostic accuracy of each testsare calculated. RESULTS: From our study we came to known that there was no statistically significant difference among various criterias in classifying pleural effusion as exudates and transudates. The misclassification of exudates and transudates by various criteria when compared to Light’s criteria is not statistically significant as p value is <0.05. CONCLUSION: From our study we came to a conclusion that to classify an exudative pleural effusion from a transudative pleural effusion - most specific test is pleural fluid total protein and - most sensitive test is pleural fluid / serum bilirubin ratio. The positive predictive value, negative predictive value and diagnostic accuracy is higher for pleural fluid total protein. To conclude, though Light's criteria remains as gold standard to differentiate transudates and exudates, in cases where there is a mismatch between clinical diagnosis and the outcome from Light's criteria, pleural fluid bilirubin / serum bilirubin ratio and pleural fluid total protein evaluation may add to the diagnostic accuracy.