Usefulness of pleural fluid cholesterol in the diagnosis of tuberculous pleural effusion

Susanta Kumar Paul; Shamim Ahmed; Rajashish Chakrabortty; Shuvo Majumder; Dip Jyoti Sarker; Shamrat Kumar Paul; Samprity Islam; Mohammed Atiqur Rahman

doi:10.18203/2320-6012.ijrms20232767

Authors

Susanta Kumar Paul Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
Shamim Ahmed Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
Rajashish Chakrabortty Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
Shuvo Majumder Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
Dip Jyoti Sarker Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
Shamrat Kumar Paul Department of Biochemistry and Molecular Biology, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
Samprity Islam Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
Mohammed Atiqur Rahman Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20232767

Keywords:

Diagnosis, Pleural fluid cholesterol, Tuberculous pleural effusion

Abstract

Background: Tuberculous pleural effusion (TPE) is the most common etiology of exudative pleural effusion in high tuberculosis burden countries like Bangladesh. The usefulness of pleural fluid cholesterol for the diagnosis of TPE is not evaluated yet. This study aimed to assess the usefulness of pleural fluid cholesterol for the diagnosis of TPE.

Methods: This cross-sectional study was conducted at the department of respiratory medicine at Bangabandhu Sheikh Mujib medical university. A total of thirty-five TPE was included in this study. Pleural fluid aspiration followed by cytological (total count, differential count), and biochemical (protein, glucose, lactate dehydrogenase, adenosine deaminase, and cholesterol) investigations were done. At the same time, blood was sent for biochemical (protein, glucose, and lactate dehydrogenase) investigation. Pleural biopsy followed by a histopathological examination was done to confirm TPE. Ethical clearance was obtained from the institutional review board (IRB) prior to starting this study.

Results: In our study, the mean age of the participants was 35.54±14.13 years, and male predominant (74.3%). The mean pleural fluid cholesterol was 99.87±23.82 mg/dl. With a cut of value 69.85, the sensitivity, specificity, and accuracy were 97.14%, 57.14%, and 77.14% respectively.

Conclusions: Pleural fluid cholesterol has significant diagnostic usefulness for the diagnosis of tuberculous pleural effusion.

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References

Light RW. Update on tuberculous pleural effusion. Respirology. 2010;15(3):451-8.

Yurt S, Kirkil G. Diagnostic utility of adenosine deaminase 1-2, and interferon-? in the diagnosis of pleural tuberculosis. J Infectiol Epidemiol. 2018;2(1):1-4.

Porcel JM. Biomarkers in the diagnosis of pleural diseases: a 2018 update. Ther Adv Respir Dis. 2018;12:1753466618808660.

Chen ML, Yu WC, Lam CW, Au KM, Kong FY, Chan AYW. Diagnostic value of pleural fluid adenosine deaminase activity in tuberculous pleurisy. Clin Chim Acta. 2004;341(1-2):101-7.

Dheda K, van Zyl-Smit RN, Sechi LA, Badri M, Meldau R, Meldau S, et al. Utility of quantitative T-cell responses versus unstimulated interferon-(gamma) for the diagnosis of pleural tuberculosis. Eur Respir J. 2009;34(5):1118-26.

Hamm H, Brohan U, Bohmer R, Missmahl HP. Cholesterol in pleural effusions. A diagnostic aid. Chest. 1987;92(2):296-302.

Valdés L, Alvarez D, San José E, Juanatey JR, Pose A, Valle JM, et al. Value of adenosine deaminase in the diagnosis of tuberculous pleural effusions in young patients in a region of high prevalence of tuberculosis. Thorax. 1995;50(6):600-3.

Hamal AB, Yogi KN, Bam N, Das SK, Karn R. Pleural fluid cholesterol in differentiating exudative and transudative pleural effusion. Pulm Med. 2013;2013:135036.

Duggal D, Yannawar A, Dharmadhikari V. Pleural fluid ada in the diagnosis of pleural effusion. J Evol Med Dent Sci. 2017;6: 4421-9.

Dave V, Patel SJ, Shah A. Pleural fluid adenosine deaminase for diagnosis of tuberculous pleural effusion. Int J Res Med. 2018;7(2):41-9.

Ungerer JP, Oosthuizen HM, Retief JH, Bissbort SH. Significance of adenosine deaminase activity and its isoenzymes in tuberculous effusions. Chest. 1994;106(1):33-7.

Sharma SK, Suresh V, Mohan A, Kaur P, Saha P, Kumar A, et al. A prospective study of sensitivity and specificity of adenosine deaminase estimation in the diagnosis of tuberculosis pleural effusion. Indian J Chest Dis Allied Sci. 2001;43(3):149-55.

Gupta BK, Bharat V, Bandyopadhyay D. Role of adenosine deaminase estimation in the differentiation of tuberculous and non-tuberculous exudative pleural effusions. J Clin Med Rese. 2010;2(2):79-84.

Kelam MA, Ganie FA, Shah BA, Ganie SA, Wani ML, Gani M. The diagnostic efficacy of adenosine deaminase in tubercular effusion. Oman Med J. 2013;28(6):417-21.

Maldhure BR, Bedarkar SP, Kulkarnl HR, Paplnwar SP. Pleural biopsy and adenosine deaminase in pleural fluid for the diagnosis of tubercular pleural effusion. Ind J Tuberc. 1994;41:161-5.

Sahn SA. Diagnosis and management of parapneumonic effusions and empyema. Clin Infect Dis. 2007;45(11):1480-6.

Antonangelo L, Vargas FS, Seiscento M, Bombarda S, Teixera L, Sales RK. Clinical and laboratory parameters in the differential diagnosis of pleural effusion secondary to tuberculosis or cancer. Clinics. 2007;62:585-90.

Modi SD, Agrawal AK, Bhake AS, Agrawal VR. Role of adenosine deaminase in pleural fluid in tubercular pleural effusion. J Datta Meghe Inst Med Sci Univ. 2018;13(4):163-7.

Ibrahim WH, Ghadban W, Khinji A, Yasin R, Soub H, Al-Khal AL, et al. Does pleural tuberculosis disease pattern differ among developed and developing countries? Respir Med. 2005;99(8):1038-45.

Valdés L, San José ME, Pose A, Gude F, González-Barcala FJ, Álvarez-Dobaño JM, et al. Diagnosing tuberculous pleural effusion using clinical data and pleural fluid analysis: A study of patients less than 40 years old in an area with a high incidence of tuberculosis. Respir Med. 2010;104(8):1211-7.

Reechaipichitkul W, Kawamatawong T, Teerajetgul Y, Patjanasoontorn B. Diagnostic role of pleural fluid adenosine deaminase in tuberculous pleural effusion. Southeast Asian J Trop Med Public Health. 2001;32(2):383-9.

Liam CK, Lim KH, Wong CM. Differences in pleural fluid characteristics, white cell count, and biochemistry of tuberculous and malignant pleural effusions. Med J Malay. 2000;55(1):21-8.

Mehta AA, Gupta AS, Ahmed S, Rajesh V. Diagnostic utility of adenosine deaminase in exudative pleural effusions. Lung India. 2014;31(2):142-144.

Lee J, Lee SY, Lim JK, Yoo SS, Lee SY, Cha SI, et al. Radiologic and laboratory differences in patients with tuberculous and parapneumonic pleural effusions showing non-lymphocytic predominance and high adenosine deaminase levels. Infection. 2015;43:65-71.

Bamaniya DA, Patel MZ, Kaptan KR. Pleural fluid LDH Cholesterol and ADA levels: useful biochemical markers in comparison to Light’s criteria for the more rapid and accurate evaluation of pleural effusion. Int J Med Sci Public Health. 2014;3(7):870-5.

Goyal V, Agarwal Y, Singh BS, Abhishek S. Efficacy of estimating pleural fluid cholesterol in diagnosing tubercular pleural effusion. Sch J Appl Med Sci. 2017;5(10):4105-13.