Limits...
Is albumin gradient or fluid to serum albumin ratio better than the pleural fluid lactate dehydroginase in the diagnostic of separation of pleural effusion?

Joseph J, Badrinath P, Basran GS, Sahn SA - BMC Pulm Med (2002)

Bottom Line: The median and inter quartile ranges (IQR) for SEAG 93.5 (33.8 to 122.5) g/dl, ALBR 0.49 (0.42 to 0.62) and FLDH 98.5 IU/L(76.8 to 127.5) in transudates were significantly lower than the corresponding values for exudates 308.5 (171 to 692), 0.77 (0.63 to 0.85), 344 (216 to 695) all p < 0.0001.There was a significant negative correlation between SEAG and ALBR (r= -0.89, p < 0.0001).FLDH is a superior test compared to SEAG and ALBR.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Faculty of Medicine & Health Science, UAE University, Al Ain, UAE. jjoseph@uaeu.ac.ae

ABSTRACT

Background: To determine the accuracy of serum-effusion albumin gradient (SEAG) and pleural fluid to serum albumin ratio (ALBR) in the diagnostic separation of pleural effusion into transudate and exudate and to compare SEAG and ALBR with pleural fluid LDH (FLDH) the most widely used test.

Methods: Data collected from 200 consecutive patients with a known cause of pleural effusion in a United Kingdom district general hospital.

Results: The median and inter quartile ranges (IQR) for SEAG 93.5 (33.8 to 122.5) g/dl, ALBR 0.49 (0.42 to 0.62) and FLDH 98.5 IU/L(76.8 to 127.5) in transudates were significantly lower than the corresponding values for exudates 308.5 (171 to 692), 0.77 (0.63 to 0.85), 344 (216 to 695) all p < 0.0001. The Area Under the Curve (AUC) with 95% confidence intervals (Cl) for SEAG, ALBR and FLDH were 0.81 (0.75 to 0.87), 0.79 (0.72 to 0.86) and 0.9 (0.87 to 0.96) respectively. The positive likelihood ratios with 95%CI for FLDH, SEAG, and ALBR were: 7.3(3.5-17), 6.3(3-15) 6.2(3-14) respectively. There was a significant negative correlation between SEAG and ALBR (r= -0.89, p < 0.0001).

Conclusion: The discriminative value for SEAG and ALBR appears to be similar in the diagnostic separation of transudates and exudates. FLDH is a superior test compared to SEAG and ALBR.

No MeSH data available.


Related in: MedlinePlus

Receiver Operating Characteristic plots of the pleural fluid FLDH, ALBR, and SEAG. The optimum cut-off level was determined by selecting the points of test values that provided the greatest sum of sensitivity and specificity. The optimum cutoff for FLDH was 163 IU/L, ALBR = 0.68, SEAG = 9.0.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC101409&req=5

Figure 1: Receiver Operating Characteristic plots of the pleural fluid FLDH, ALBR, and SEAG. The optimum cut-off level was determined by selecting the points of test values that provided the greatest sum of sensitivity and specificity. The optimum cutoff for FLDH was 163 IU/L, ALBR = 0.68, SEAG = 9.0.

Mentions: The ROC plots for SEAG, ALBR and FLDH are shown in figure-1. At all test values, FLDH was more sensitive and specific than SEAG and ALBR. The optimum cut-off levels were 163IU/L for FLDH, 9 g/L for SEAG, and 0.68 for ALBR respectively. FLDH was the best of the three tests. The AUC and the corresponding 95% Cl for SEAG, ALBR and FLDH were 0.81 (0.75 to 0.87), 0.79 (0.72 to 0.86) and 0.9 (0.87 to 0.96) respectively. Although the AUC for SEAG and ALBR were of similar magnitude, the AUC for FLDH was significantly more than the AUC for ALBR (z = 2.75, p < 0.01). Of the 156 exudates, FLDH correctly classified 132 (85%) 95% Cl 0.78–0.90, SEAG 112 (72%) 0.64–0.79, and ALBR 111 (71%) 0.63–0.78 respectively as exudates and all three tests classified 39 (89%) 0.75–0.96 of the 44 transudates correctly. Table 2 lists the positive likelihood ratios (LR +ve) with 95% Cl for the three tests at the optimum cut-off level. Figure-2 shows the correlation between SEAG and ALBR. There was a significant negative correlation between the two tests (r = -0.89, p < 0.0001).


Is albumin gradient or fluid to serum albumin ratio better than the pleural fluid lactate dehydroginase in the diagnostic of separation of pleural effusion?

Joseph J, Badrinath P, Basran GS, Sahn SA - BMC Pulm Med (2002)

Receiver Operating Characteristic plots of the pleural fluid FLDH, ALBR, and SEAG. The optimum cut-off level was determined by selecting the points of test values that provided the greatest sum of sensitivity and specificity. The optimum cutoff for FLDH was 163 IU/L, ALBR = 0.68, SEAG = 9.0.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC101409&req=5

Figure 1: Receiver Operating Characteristic plots of the pleural fluid FLDH, ALBR, and SEAG. The optimum cut-off level was determined by selecting the points of test values that provided the greatest sum of sensitivity and specificity. The optimum cutoff for FLDH was 163 IU/L, ALBR = 0.68, SEAG = 9.0.
Mentions: The ROC plots for SEAG, ALBR and FLDH are shown in figure-1. At all test values, FLDH was more sensitive and specific than SEAG and ALBR. The optimum cut-off levels were 163IU/L for FLDH, 9 g/L for SEAG, and 0.68 for ALBR respectively. FLDH was the best of the three tests. The AUC and the corresponding 95% Cl for SEAG, ALBR and FLDH were 0.81 (0.75 to 0.87), 0.79 (0.72 to 0.86) and 0.9 (0.87 to 0.96) respectively. Although the AUC for SEAG and ALBR were of similar magnitude, the AUC for FLDH was significantly more than the AUC for ALBR (z = 2.75, p < 0.01). Of the 156 exudates, FLDH correctly classified 132 (85%) 95% Cl 0.78–0.90, SEAG 112 (72%) 0.64–0.79, and ALBR 111 (71%) 0.63–0.78 respectively as exudates and all three tests classified 39 (89%) 0.75–0.96 of the 44 transudates correctly. Table 2 lists the positive likelihood ratios (LR +ve) with 95% Cl for the three tests at the optimum cut-off level. Figure-2 shows the correlation between SEAG and ALBR. There was a significant negative correlation between the two tests (r = -0.89, p < 0.0001).

Bottom Line: The median and inter quartile ranges (IQR) for SEAG 93.5 (33.8 to 122.5) g/dl, ALBR 0.49 (0.42 to 0.62) and FLDH 98.5 IU/L(76.8 to 127.5) in transudates were significantly lower than the corresponding values for exudates 308.5 (171 to 692), 0.77 (0.63 to 0.85), 344 (216 to 695) all p < 0.0001.There was a significant negative correlation between SEAG and ALBR (r= -0.89, p < 0.0001).FLDH is a superior test compared to SEAG and ALBR.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Faculty of Medicine & Health Science, UAE University, Al Ain, UAE. jjoseph@uaeu.ac.ae

ABSTRACT

Background: To determine the accuracy of serum-effusion albumin gradient (SEAG) and pleural fluid to serum albumin ratio (ALBR) in the diagnostic separation of pleural effusion into transudate and exudate and to compare SEAG and ALBR with pleural fluid LDH (FLDH) the most widely used test.

Methods: Data collected from 200 consecutive patients with a known cause of pleural effusion in a United Kingdom district general hospital.

Results: The median and inter quartile ranges (IQR) for SEAG 93.5 (33.8 to 122.5) g/dl, ALBR 0.49 (0.42 to 0.62) and FLDH 98.5 IU/L(76.8 to 127.5) in transudates were significantly lower than the corresponding values for exudates 308.5 (171 to 692), 0.77 (0.63 to 0.85), 344 (216 to 695) all p < 0.0001. The Area Under the Curve (AUC) with 95% confidence intervals (Cl) for SEAG, ALBR and FLDH were 0.81 (0.75 to 0.87), 0.79 (0.72 to 0.86) and 0.9 (0.87 to 0.96) respectively. The positive likelihood ratios with 95%CI for FLDH, SEAG, and ALBR were: 7.3(3.5-17), 6.3(3-15) 6.2(3-14) respectively. There was a significant negative correlation between SEAG and ALBR (r= -0.89, p < 0.0001).

Conclusion: The discriminative value for SEAG and ALBR appears to be similar in the diagnostic separation of transudates and exudates. FLDH is a superior test compared to SEAG and ALBR.

No MeSH data available.


Related in: MedlinePlus