PURPOSE: Pleural fluid analysis is frequently not helpful diagnostically and only establishes a definitive diagnosis in a minority of patients. Kings County Hospital Center (KCHC) is an inner city hospital that serves a population where tuberculosis is highly prevalent. Adenosine deaminase is a very useful test, but its results usually take 1 to 2 weeks. We sought to look for clues suggestive of TB pleuritis vs. malignancy in patients presenting with exudative pleural effusion (PE) at our center.
METHODS: Clinical data and outcome variables were extracted from the medical records of 46 adult patients presenting at KCHC with an exudative pleural effusion, due to tuberculosis (TB) or malignancy from January 2001 to December 2006. Patients with known history of malignant PE were excluded. Data are presented as mean ± SD. A p value of <0.05 was considered statistically significant.
RESULTS: 14 patients (10 men and 4 women) with tuberculous pleuritis and 32 patients (20 women and 12 men) with malignant pleural effusion were identified. The group of TB pleuritis was younger (49.1 ± 21.9 vs. 61.9 ± 13.3 years; p:0.02) and showed a male predominance (71.4% vs. 37.5%; p:0.03). Both groups had similar cell count and differential (table), glucose and lactate dehydrogenase (LDH). Patients with TB pleuritis had a higher pleural pH and a lower pleural and serum albumin levels (p<0.05). A pleural albumin level < 2 g/dL had 66% sensitivity and 90% specificity in differentiating patients with TB pleuritis.
CONCLUSION: A low PF albumin was highly suggestive of TB pleuritis. Richter C et al, previously reported similar findings in patients with HIV and TB pleuritis.
CLINICAL IMPLICATIONS: TB pleuritis is more likely in younger male patient presenting to our center with lymphocytic PE, and have a higher pleural pH and a lower albumin levels.
DISCLOSURE: Muhammad Iqbal, None.