THE DIAGNOSTIC VALUE OF PLEURAL CHOLESTEROL IN THE DIFFERENTIATION BETWEEN PLEURAL EXUDATES AND TRANSUDATES
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In the evaluation of pleural effusion , its classification as either exudate or transudate is a first diagnostic step. The aim of this study is to validate the use of pleural cholesterol (PCHOL) and the pleural cholesterol / serum cholesterol ratio (P/S CHOL) for differentiating between transudates and exudates. The parameters pleural protein (PPROT), pleural protein/sehim protein ratio (P/S PROT) were compared with pleural cholesterol (PCHOL) and the pleural cholesterol / serum cholesterol ratio (P/S CHOL) with regard to their usefulness for differentiating between pleural exudates and transudatcs, the PCHOL values were 34.718.9 mg/dl for transudates, 74.2±28.5 mg/di for neoplastic exudates, 90.21-14.8mg/d1 for tuberculous exudates and 101.9125.6 mg/di for parapneumonic exudates. PCHOL values were statistically significantly (P<0.001) increased in all exudate groups as compared to transudate group. The sensitivity and specificity of PPROT for diagnosis of exudates were both 80% The sensitivity and speccity of P/S PROT for diagnosis of exudates were 82.5% and 90% respectively. All transudates and 5 of the 40 exudates had PCHOL values below 55 mg/di, so that with this threshold, PCHOL had a sensitivity of 87.5% and a specificity of 100% for diagnosis of exudates. With a threshold of 0.38, P/S CHOL had a sensitivity of 80% and a specificity of 87.5% The number of misclassifications by PCHOL (10%) was less than with any other' of the parameters. So it is recommended to measure PCHOL and P/S CHOL routinely in differentiation between pleural exudate and pleural transudate.