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Original Research: Disorders of the Pleura |

Effects of Coexisting Pneumonia and End-stage Renal Disease on Pleural Fluid Analysis in Patients With Hydrostatic Pleural EffusionPleural Effusion and Coexisting Disorders

Peter Doelken, MD; John T. Huggins, MD; Mark Goldblatt, DO; Paul Nietert, PhD; Steven A. Sahn, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Doelken), Albany Medical College, Albany, NY; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine (Drs Huggins and Sahn) and Division of Biostatistics and Epidemiology (Dr Nietert), Medical University of South Carolina, Charleston, SC; and Mission Hospital (Dr Goldblatt), Asheville, NC.

Correspondence to: Peter Doelken, MD, Division of Pulmonary and Critical Care Medicine, Albany Medical College, 43 New Scotland Ave, MC 91, Physicians Pavilion, 4th Floor, Albany, NY 12208; e-mail: Doelkep@mail.amc.edu


Funding/Support: This study was supported by the National Center for Research Resources (award number UL1RR029882).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(6):1709-1716. doi:10.1378/chest.12-2221
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Background:  In individual patients, especially those who are hospitalized, several conditions often coexist that may be responsible for the development of a pleural effusion and may affect the pleural fluid analysis (PFA). The objective of this study was to investigate the effects of end-stage renal disease and pneumonia on PFA in patients with hydrostatic pleural effusion.

Methods:  In a retrospective analysis of 1,064 consecutive patients who underwent thoracentesis at a university hospital, cell counts and pleural fluid protein, lactate dehydrogenase, pH, and glucose levels were examined in those (n = 300) with clinical evidence of hydrostatic pleural effusion.

Results:  The 300 patients (28.1%) with pleural effusions had congestive heart failure (CHF), circulatory overload (CO), or both. Expert consensus was achieved in 66 (22%) for CHF as the sole diagnosis (SCHF), 30 (10%) for CHF and coexisting pneumonia (PCHF), and 26 (8.7%) for end-stage renal disease (ESRD) with coexisting CO or CHF. The remaining 178 patients were excluded because of complicating conditions. There were minor, but statistically significant differences in pleural fluid/serum protein ratios in patients with ESRD with coexisting CO or CHF compared with SCHF. Compared with SCHF, there were statistically significant tendencies for higher protein and lactate dehydrogenase concentrations and lower pH levels in those with PCHF. The total nucleated cell count and the absolute neutrophil count were significantly higher in PCHF.

Conclusions:  ESRD in patients with hydrostatic pleural effusions has a minimal effect on the PFA. Coexisting pneumonia most often results in an exudative effusion in patients with CHF.

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