Combined Pleural Fluid Cholesterol and Total Protein in Differentiation of Exudates and Transudates in Cases Presenting in Tribhuvan University Teaching Hospital

Pleural effusions are very common clinical findings; we came across in clinical practice. Their proper diagnosis based on different parameters like pleural fluid protein, LDH, ADA, cholesterol is very important. Lights criteria though used as standard method in differentiating pleural effusions as exudates and transudates, it usually misidentifies 15-20 % of transudates as exudates. Hence, role of other criteria like combined pleural fluid cholesterol and total protein in differentiation of pleural fluid is studied in this study. The general objective was to study role of combined pleural fluid cholesterol and total protein in differentiation of exudates and transudates in cases presenting in Tribhuvan University Teaching Hospital. 90 patients with pleural effusion were enrolled in this study. Out of 90 patients, 49 patients were from male sex which is equal to 54.4% and 41 patients were from female sex which is equal to 45.6%. Right-sided pleural effusion (66.7%) was predominant in our study. By diagnosis on discharge out of 90 samples 62(68.9%) were exudates and 28(31.1%) were transudates. Based on Light’s criteria, 65 (72.2%) pleural effusions were found to be exudates and 25 were found to be transudates, with sensitivity and specificity of 98.4 % and 85.7 % respectively. According to pleural fluid total protein, it classified 62.2 % [n=56] of cases as exudates and 37.8 % [n=34] of cases as transudates. Sensitivity and specificity with 88.7 % and 96.4 % respectively. Based on pleural fluid cholesterol, our study showed 64.4% [n=58] of cases as exudates and 35.6% [n= 32] of cases as transudates with sensitivity and specificity of 93.5 % and 100 % respectively. Combined pleural total protein and cholesterol however classified 57.8% [n=52] of cases as exudates and 42.2% [n=38] of cases as exudates with sensitivity and specificity of 83.9 % and 100 % respectively Though Light’s criteria remain the gold standard for distinguishing transudates from exudates, combined pleural fluid cholesterol and total protein examination may improve diagnostic accuracy in circumstances where the diagnosis on discharge differs from the outcome from Light’s criteria.