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Communications to the Editor |

Pleural to Serum Cholinesterase Ratio in Separation of Transudative and Exudative Pleural Effusions Pleural to Serum Cholinesterase Ratio in Separation of Transudative and Exudative Pleural Effusions FREE TO VIEW

Tülin Sevim, MD; Gökay Güngör, MD; Kemal Tahaoğlu, MD
Author and Funding Information

Affiliations: Süreyyapaşa Center for Chest Disease and Thoracic Surgery. Istanbul, Turkey,  Hospital Vega Baja Orihuela-Alicante, Spain Hospital General Universitari d’Elx Alicante, Spain

Correspondence to: Tülin Sevim Sokullu sok, MD, Anadolu siteleri Seymanoğlu, Apt No. 13 D:6 Posta kod:81010, Acıbadem/Kadıköy, İstanbul, Turkiye; e-mail: tsevim@ixir.com



Chest. 2001;119(3):989-990. doi:10.1378/chest.119.3.989
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To the Editor:

We read with interest the report by Garcia-Pachon et al (July 1996)1 in that they showed that the pleural fluid (PF) to serum (S) cholinesterase ratio was an accurate criterion for separating pleural transudates and exudates. We would like to extend this observation with our own experience.

We prospectively studied 78 patients admitted to our clinic who underwent a diagnostic thoracentesis over a 2-year period. There were 69 men (88.5%) and 9 women (11.5%) with a mean (± SD) age of 50.14 ± 17.8 years (range, 15 to 78 years). Effusions were individually classified as transudates or exudates after the careful evaluation of all clinical data and results from the patients. There were 28 transudates (35.9%; 22 secondary to congestive heart failure, 4 secondary to nephrosis, and 2 secondary to liver cirrhosis) and 50 exudates (64.1%; 23 from tuberculosis, 22 neoplastic, 4 parapneumonic, and 1 postsurgery).

The PF cholinesterase level was, on average, 872.2 ± 411.5 U/L in transudates and 3,844.6 ± 1,542.2 U/L in exudates (p < 0.001). Using a cutoff level of > 1,700 U/L to define an exudate, eight effusions (10.3%) were falsely classified. Of these, one was a transudate (3.6%) and seven were exudates (14%). The mean PF/S cholinesterase ratio was, on average, 0.17 ± 0.06 in transudates and 0.55 ± 0.21 in exudates (p < 0.001). Using a cutoff level of> 0.29 to define an exudate, three effusions (3.8%) were misclassified. Of these, one was a transudate (3.6%) and two were exudates (8.6%).

Using the criteria of Light et al,2 six effusions (7.7%) were misclassified. Of these, five were transudates (17.8%) and one was an exudate (2%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PF cholinesterase, PF/S cholinesterase ratio, and the criteria of Light et al are shown in Table 1 .

We agree with Garcia-Pachon et al1 that the PF/S cholinesterase ratio is an accurate parameter for the separation of transudates and exudates.

Table Graphic Jump Location
Table 1. Usefulness of Different Parameters in the Separation of Transudates and Exudates*

*Values given as percentages. PPV = positive predictive value; NPV = negative predictive value.

Garcia-Pachon, E, Padilla-Navas, I, Sanchez, JF, et al (1996) Pleural fluid to serum cholinesterase ratio for the separation of transudates and exudates.Chest110,97-101. [CrossRef] [PubMed]
 
Light, RW, MacGregor, MI, Luchsinger, PC, et al Pleural effusions: the diagnostic separation of transudates and exudates.Ann Intern Med1972;77,507-513. [PubMed]
 

Pleural to Serum Cholinesterase Ratio in Separation of Transudative and Exudative Pleural Effusions

To the Editor:

We thank Dr. Sevim and colleagues for their interest in our article (July 1996).1At present, we do not recommend the use of the pleural fluid to serum cholinesterase ratio (PF/S ChE) for the separation of transudates and exudates. Although this test has a similar accuracy to that of the criteria of Light et al, we found that a significant number of misclassified exudates with the PF/S ChE were malignant,2 and this fact is a very important limitation on its clinical use.

References
Garcia-Pachon, E, Padilla-Navas, I, Sanchez, JF, et al Pleural fluid to serum cholinesterase ratio for the separation of transudates and exudates.Chest1996;110,97-101. [CrossRef] [PubMed]
 
Garcia-Pachon, E, Padilla-Navas, I, Molina, M, et al Relacion entre colinesterasa pleural y serica para diferenciar trasudados y exudados: reevaluacion en 177 pacientes.Rev Clin Esp1998;198,129-132. [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1. Usefulness of Different Parameters in the Separation of Transudates and Exudates*

*Values given as percentages. PPV = positive predictive value; NPV = negative predictive value.

References

Garcia-Pachon, E, Padilla-Navas, I, Sanchez, JF, et al (1996) Pleural fluid to serum cholinesterase ratio for the separation of transudates and exudates.Chest110,97-101. [CrossRef] [PubMed]
 
Light, RW, MacGregor, MI, Luchsinger, PC, et al Pleural effusions: the diagnostic separation of transudates and exudates.Ann Intern Med1972;77,507-513. [PubMed]
 
Garcia-Pachon, E, Padilla-Navas, I, Sanchez, JF, et al Pleural fluid to serum cholinesterase ratio for the separation of transudates and exudates.Chest1996;110,97-101. [CrossRef] [PubMed]
 
Garcia-Pachon, E, Padilla-Navas, I, Molina, M, et al Relacion entre colinesterasa pleural y serica para diferenciar trasudados y exudados: reevaluacion en 177 pacientes.Rev Clin Esp1998;198,129-132. [PubMed]
 
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