Abstract
Objective: To compare between light's criteria and serum-effusion (S-E)albumin gradient in diagnosis of transudate effusion in CHF patients.
Material and method: Eighty-six patients who had pleural effussion and suspected CHF were enrolled in this study between October 2008-September 2010. Suspected CHF was defined by clinical or echocardiography. Inform consents were done in all volunteers. Exclusion criteria was previous thoracotomy or coronary by pass graft 3 month before study. Thoracocentesis was done to evaluate transudate effusion by light's criteria and S-E albumin gradient > 1.2 mg/dl. Definite diagnosis of pure CHF was no effusion after treatment with diuresis and pleural ProBNP > 4000 ng/dl. Combination of pleural disease and CHF were defined by confirmed pleural disease with pleural biopsy and/or VAT, partial response with diuresis and high pleural ProBNP
Result: 12 (13.95%), 56 (65.11%), 17 (19.76%) of all were pure pleural disease, pure CHF, combination of pleural disease and CHF. Sensitivity/specificity/accuracy of S-E albumin gradients and light's criteria and in diagnosis of CHF (both pure and combined) were 90.1/33.3/80.2%, 64.7/80.0/67.4%. No correlation between amount of diuretic drug and “exudate” criteria from lights' (p=.66).25 (27.2%) patients were previous post thoracotomy or coronary bypass graft. 7 of 25 patients had loculated effusion. There was correlation between previous surgery with loculated effusion and effusion from combination of pleural disease and CHF (p=.22).
Conclusion: There is benefit to use S-E albumin gradient > 1.2 mg/dl to diagnosis patients who suspected CHF with or without pleural disease. No correlation between diuresis and exudate from Light's criteria.
- © 2011 ERS
