Disorders of the Pleura |

Cholesterol Level in Pleural Fluid: An Alternative Interpretation FREE TO VIEW

Rosa Mirambeaux Villalona, MD; Esteban Perez Rodriguez, PhD; Paola Arrieta Narvaez, MD; Carolina Gotera, MD; Carolina Jurkojc Mohremberger, MD; Deisy Barrios Barreto, MD; Patricia Lazo Meneses, MD; Salvador Diaz Lobato, PhD; Sagrario Mayoralas Alises, PhD
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Ramon y Cajal Hospital, Madrid, Spain

Chest. 2014;145(3_MeetingAbstracts):271A. doi:10.1378/chest.1821747
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SESSION TITLE: Pleural Disease/Pleural Effusion Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: This study tries to determine the usefulness of the cholesterol in differentiating transudative and exudative pleural effusion, to value its usefulness to distinguish pleural benign effusion from malignant, and to identify the meaning of high levels of cholesterol in pleural fluid.

METHODS: 2558 cases were analized according to the protocol of the unit of pleura that includes: pH, biochemistry in pleural fluid, cell count, cytology, microbiology, and pleural biopsy. All the cases were closed by a final diagnosis. The statistical applied analysis has been descriptive of percentage, average rate ± standard deviation (SD), Mann-Whitney U and assessment of sensitivity and specificity terms.

RESULTS: Since 1994 to October 2012, 5896 pleural effusions have been studied in our pleural unit, among them 2558 cases were analyzed: 1621 (63.4 %) men and 937 (36.6 %) women. 2379 cases with definite clinical diagnosis were included, in which 2058 cases (86.5%) were exudates, and 321 cases (13.5%) were transudates. The mean pleural cholesterol level was 85± 58.9 mg/dl for exudates, and 37.2± 26.3 mg/dl for transudates (p <0.01). The area under the COR curve was 0.88 and the best point of cohorts to identify exudates was ≥47 mg/dl, with sensibility of 87 % and specificity of 71.1 %. Out of the 2058 cases of exudates, 1174 (57%) were benign, and 884 (42.9%) were malignant with an average of 83.96 ± 39.7 and 86.39 ± 77.5 respectively (p> 0.05). It was found cholesterol levels >100 mg/dL in 599 cases, 502 (83.8%) were malignant and 167 (27.9%) were benign, in which 61 (10.2%) corresponded to the diagnosis of pulmonary tuberculosis.

CONCLUSIONS: Level of cholesterol in pleural fluid ≥47 mg/dl is useful to discriminate exudates from transudates with 87 % of sensibility and 71 % of specificity. Cholesterol is not sufficient to discriminate between pleural benign and malignant pleural effusions, but the cholesterol level >100 mg/dL is associated to malignant and tuberculosis pleural effusions.

CLINICAL IMPLICATIONS: Provide important reference criteria in differentiating the diagnosis of patients with pleural effusion.

DISCLOSURE: The following authors have nothing to disclose: Rosa Mirambeaux Villalona, Esteban Perez Rodriguez, Paola Arrieta Narvaez, Carolina Gotera, Carolina Jurkojc Mohremberger, Deisy Barrios Barreto, Patricia Lazo Meneses, Salvador Diaz Lobato, Sagrario Mayoralas Alises

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