Pleural, peritoneal and pericardial effusions - A biochemical approach

Biochemia Medica

Volumn 24, Issue 1, 2014, Pages 123-137

  Kopcinovic, Lara Milevoj ^a   Culej, Jelena ^a  

^a SESTRE MILOSRDNICE UNIVERSITY HOSPITAL   (Croatia)

Author keywords

Pericardial effusion; Peritoneal effusion; Pleural effusion

Indexed keywords

ADENOSINE DEAMINASE; ALBUMIN; ALKALINE PHOSPHATASE; AMINO TERMINAL PRO BRAIN NATRIURETIC PEPTIDE; AMYLASE; CA 125 ANTIGEN; CA 15-3 ANTIGEN; CARCINOEMBRYONIC ANTIGEN; CHOLESTEROL; COMPLEMENT COMPONENT C4; CREATINE KINASE; CREATININE; CYTOKERATIN 19 FRAGMENT; GAMMA INTERFERON; GLUCOSE; HAPTOGLOBIN; INTERLEUKIN 1BETA; INTERLEUKIN 6; INTERLEUKIN 8; LIPOPROTEIN; PROCALCITONIN; TRIACYLGLYCEROL; TUMOR NECROSIS FACTOR ALPHA; URIC ACID;

ASCITES FLUID; BIOCHEMISTRY; CHYLOTHORAX; CLINICAL PRACTICE; COMPUTER ASSISTED TOMOGRAPHY; COST EFFECTIVENESS ANALYSIS; CYTOLOGY; HUMAN; PERICARDIAL EFFUSION; PERITONEUM EXUDATE; PLEURA EFFUSION; PLEURA FLUID; REVIEW; SENSITIVITY AND SPECIFICITY; TUBERCULOUS PLEURISY;

PERICARDIAL EFFUSION; PERITONEAL EFFUSION; PLEURAL EFFUSION;

ASCITIC FLUID; BIOLOGICAL MARKERS; CLINICAL LABORATORY TECHNIQUES; EXUDATES AND TRANSUDATES; HUMANS; PERICARDIAL EFFUSION; PLEURAL EFFUSION;

EID: 84893594187     PISSN: 13300962     EISSN: None     Source Type: Journal    
DOI: 10.11613/BM.2014.014     Document Type: Review

References (76)

1. Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults. Am Fam Physician 2006;73:1211-20.
2. Light RW. Pleural effusions. Med Clin N Am 2011;95:1055-70. http://dx.doi.org/10.1016/j.mcna.2011.08.005.
3. Balfe A, Barry S, Blake O, Cannon D, Healy M, Kilbane M et al. Association of Clinical Biochemists in Ireland. The biochemistry of body fluids [Electronic version]. Available at. http://www.acbi.ie/. Accessed July 23rd 2013.
4. Hassan T, Al-Alawi M, Chotirmall SH, McElvaney NG. Pleural fluid analysis: standstill or a work in progress? Pulm Med Hindawi 2012 (article ID 716235).
5. Light RW. Pleural effusion. N Engl J Med 2002;346:1971-7. http://dx.doi.org/10.1056/NEJMcp010731.
6. Burgess LJ. Biochemical analysis of pleural, peritoneal and pericardial effusions. Clin Chim Acta 2004;343:61-84. http://dx.doi.org/10.1016/j.cccn.2004.02.002.
7. McGrath EE, Anderson PB. Diagnosis of pleural effusion: a systematic approach. Am J Crit Care 2011;20:119-28. http://dx.doi.org/10.4037/ajcc2011685.
8. Segura RM. Useful clinical biological markers in diagnosis of pleural effusions in children. Paed Respir Rev 2004;5(Suppl A):S205-12. http://dx.doi.org/10.1016/S1526-0542(04)90039-5.
9. Roth BJ, O'Meara TF, Hal Cragun W. The serum-effusion albumin gradient in the evaluation of pleural effusions. Chest 1990;98:546-9. http://dx.doi.org/10.1378/chest.98.3.546.
10. Tarn AC, Lapworth R. Biochemical analysis of pleural fluid: what should we measure? Ann Clin Biochem 2001;38:311-22. http://dx.doi.org/10.1258/0004563011900812.
11. Romero-Candeira S, Hernandez L, Romero-Brufao S, Orts D, Fernandez C, Martin C. Is it meaningful to use biochemical parameters to discriminate between transudative and exudative pleural effusions? Chest 2002;122:1524-9. http:// dx.doi.org/10.1378/chest.122.5.1524.
12. Ferraz Maranhao BH, da Silva Junior CT, da Silva Chibante AM, Perez Cardoso G. Determination of total proteins and lactate dehydrogenase for the diagnosis of pleural transudates and exudates: redefining the classical criterion with a new statistical approach. J Bras Pneumol 2010;36:468-74.
13. Hamm H, Brohan U, Bohmer R, Missmahl HP. Cholesterol in pleural effusions. Chest 1987;92:296-302. http://dx.doi.org/10.1378/chest.92.2.296.
14. Romero S, Candela A, Martin C, Hernandez L, Trigo C, Gil J. Evaluation of different criteria for the separation of pleural transudates from exudates. Chest 1993;104:399-404. http://dx.doi.org/10.1378/chest.104.2.399.
15. Burgess LJ, Maritz FJ, Frans Taljaard JJ. Comparative analysis of the biochemical parameters used to distinguish between pleural transudates and exudates. Chest 1995;107:1604-9. http://dx.doi.org/10.1378/chest.107.6.1604.
16. Porcel JM, Vives M, Vicente De Vera MC, Cao G, Rubio M, Rivas C. Useful tests on pleural fluid that distinguish transudates from exudates. Ann Clin Biochem 2001;38:671-5. http://dx.doi.org/10.1258/0004563011901082.
17. Costa M, Quiroga T, Cruz E. Measurement of pleural fluid cholesterol and lactate dehydrogenase. A simple and accurate set of indicators for separating exudates from transudates. Chest 1995;108:1260-3. http://dx.doi.org/10.1378/chest.108.5.1260.
18. Digensoy O, Celik N, Kul S, Gogebakan B, Bayram H, Light RW. Ischemia modified albumin in the differential diagnosis of pleural effusions. Respiratory Medicine 2011;105:1712-7. http://dx.doi.org/10.1016/j.rmed.2011.07.015.
19. Metintas M, Alatas O, Alatas F, Colak O, Ozdemir N, Erginel S. Comparative analysis of biochemical parameters for differentiation of exudates from transudates. Light's criteria, cholesterol, bilirubin, albumin gradient, alkaline phosphatase, creatin kinase, and uric acid. Clin Chim Acta 1997;264:149-62. http://dx.doi.org/10.1016/S0009-8981(97)00091-0.
20. Porcel HM, Vives M, Cao G, Esquerda A, Rubio M, Rivas C. Measurement of pro-brain natriuretic peptide in pleural fluid for the diagnosis of pleural effusions due to heart failure. Am J Med 2004;116:417-20. http://dx.doi.org/10.1016/j.amjmed.2003.11.008.
21. Romero-Candeira S, Fernandez C, Martin C, Sanchez-Paya J, Hernandez L. Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure. Am J Med 2001;110:681-6. http://dx.doi.org/10.1016/S0002-9343(01)00726-4.
22. McGrath EE, Warriner D, Anderson PB. The use of non-routine pleural fluid analysis in the diagnosis of pleural effusion. Resp Med 2010;104:1092-100. http://dx.doi.org/10.1016/j.rmed.2010.03.008.
23. Porcel JM, Martinez-Alonso M, Cao G, Bielsa S, Sopena A, Esquerda A. Biomarkers of heart failure in pleural fluid. Chest 2009;136:671-7. http://dx.doi.org/10.1378/chest.09-0270.
24. Kolditz M, Halank M, Schienmanck CS, Schmeisser A, Hoffken G. High diagnostic accuracy of NT-proBNP for cardiac origin of pleural effusions. Eur Respir J 2006;28:144-50. http://dx.doi.org/10.1183/09031936.06.00113205.
25. Han CH, Choi JE, Ching JH. Clinical utility of pleural fluid NTpro brain natriuretic peptide (NT-proBNP) in patients with pleural effusions. Inter Med 2008;47:1669-74. http://dx.doi.org/10.2169/internalmedicine.47.1276.
26. Heffner JE, Brown LK, Barbieri CA. Diagnostic value of tests that discriminate between exudative and transudative pleural effusions. Chest 1997;111:970-80. http://dx.doi.org/10.1378/chest.111.4.970.
27. Heffner JE, Sahn SA, Brown LK. Multilevel likelihood ratios for identifying exudative pleural effusions. Chest 2002;121:1916-20. http://dx.doi.org/10.1378/chest.121.6.1916.
28. Heffner JE, Highland K, Brown LK. A meta-analysis derivation of continuous likelihood ratios for diagnosing pleural fluid exudates. Am J Respir Crit Care Med 2003;167:1591-9. http://dx.doi.org/10.1164/rccm.200301-048PP.
29. Porcel JM, Pena JM, Vicente de Vera C, Esquerda A, Vives M, Light RW. Bayesian analysis using continuous likelihood ratios for identifying pleural exudates. Resp Med 2006;100:1960-5. http://dx.doi.org/10.1016/j.rmed.2006.02.025.
30. Sahn SA. Getting the most from pleural fluid analysis. Respirology 2012;17:270-7. http://dx.doi.org/10.1111/j.1440-1843.2011.02100.x.
31. Maskell NA, Butland RJA. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003;58(Suppl II):ii8-ii17. http://dx.doi.org/10.1136/thx.58.suppl_2.ii8.
32. Skouras V, Kalomenidis I. Chylothorax: diagnostic approach. Curr Opin Pulm Med 2010;16:387-93. http://dx.doi.org/10.1097/MCP.0b013e328338dde2.
33. Krenke R, Korczynski P. Use of pleural fluid levels of adenosine deaminase and interferon gamma in the diagnosis of tuberculous pleuritis. Curr Opin Pulm Med 2010;16:367-75. http://dx.doi.org/10.1097/MCP.0b013e32833a7154.
34. Hiraki A, Aoe K, Eda R, Maeda T, Murakami T, Sugi K, Takeyama H. Comparison of six biological markers for the diagnosis of tuberculous pleuritis. Chest 2004;125:987-9. http://dx.doi.org/10.1378/chest.125.3.987.
35. Jiang J, Shi HZ, Liang QL, Qin SM, Qin XJ. Diagnostic value of interferon-γ in tuberculous pleurisy. Chest 2007;131:1133-41.http://dx.doi.org/10.1378/chest.06-2273.
36. Trajman A, Pai M, Dheda K, van Zyl Smit R, Zwerling AA, Joshi R, et al. Novel tests for diagnosing tuberculous pleural effusion: what works and what does not? Eur Respir J 2008;31:1098-106. http://dx.doi.org/10.1183/09031936.00147507.
37. McGrath EE, Warriner D, Anderson PB. Pleural fluid characteristics of tuberculous pleural effusions. Heart Lung 2010;39:540-3. http://dx.doi.org/10.1016/j.hrtlng.2009.12.004.
38. Liang QL, Shi HZ, Wang K, Qin SM, Qin XJ. Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy: a meta-analysis. Respir Med 2008;102:744-54. http://dx.doi.org/10.1016/j.rmed.2007.12.007.
39. Ferrer J, Villarino MA, Encabo G, Felip E, Bermejo B, Vila S, Orriols R. Diagnostic utility of CYFRA 21-1, carcinoembryonic antigen, CA 125, neuron specific enolase, and squamous cell antigen level determinations in the serum and pleural fluid of patients with pleural effusions. Cancer 1999;86:1488-95. http://dx.doi.org/10.1002/(SICI)1097-0142(19991015)86:81488::AID-CNCR153.0.CO;2-Y.
40. Porcel JM, Vives M, Esquerda A, Salud A, Perez B, Rodriguez-Panadero F. Use of a panel of tumor markers (carcinoembryonic antigen, cancer antigen 125, carbohydrate antigen 15-3, and cytokeratin 19 fragments) in pleural fluid for the differential diagnosis of benign and malignant effusion. Chest 2004;126:1757-63. http://dx.doi.org/10.1378/chest.126.6.1757.
41. Villena V, Perez V, Pozo F, Lopez-Encuentra A, Echave-Sustaeta J, Arenas J, Escribano PM. Amylase levels in pleural effusions: a consecutive unselected series of 841 patients. Chest 2002;121:470-4. http://dx.doi.org/10.1378/chest.121.2.470.
42. Branca P, Rodriguez RM, Rogers JT, Ayo DS, Moyers JP, Light RW. Routine measurement of pleural fluid amylase is not indicated. Arch Intern Med 2001;161:228-32. http://dx.doi.org/10.1001/archinte.161.2.228.
43. Light RW. The undiagnosed pleural effusion. Clin Chest Med 2006;27:309-19. http://dx.doi.org/10.1016/j.ccm.2005.12.002.
44. Kiropoulos TS, Kostikas K, Oikonomidi S, Tsilioni I, Nikoulis D, Germenis A, Gourgoulianis KI. Acute phase markers for the differentiation of infectious and malignant pleural effusions. Respir Med 2007;101:910-18. http://dx.doi.org/10.1016/j.rmed.2006.09.019.
45. Tarn AC, Lapworth R. Biochemical analysis of ascitic (peritoneal) fluid: what should we measure? Ann Clin Biochem 2010;47:397-407. http://dx.doi.org/10.1258/acb.2010.010048.
46. Sood R. Ascites: diagnosis and management. Journal of Indian Academy of Clinical Medicine 2000;5:80-9.
47. Runyon BA. Management of adult patients with ascites due to cirrhosis. Hepatology 2004;39:841-56. http://dx.doi.org/10.1002/hep.20066.
48. Saravanan R, Cramp ME. Investigation and treatment of ascites. Clin Med JRCPL 2002;2:310-3. http://dx.doi.org/10.7861/clinmedicine.2-4-310.
49. Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchinson JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Int Med 1992;117:215-20. http://dx.doi.org/10.7326/0003-4819-117-3-215.
50. Vyakaranam S, Nori S, Sastry G, Vyakaranam SB, Bhongir AV. Serum-ascites albumin and cholesterol gardients in differential diagnosis of ascites. NJIRM 2011;2:22-8.
51. Alexandrakis MG, Moschandrea JA, Koulocheri SA, Kouroumalis E, Eliopoulos GD. Discrimination between malignant and nonmalignant ascites using serum and ascitic fluid proteins in a multivariate model. Dig Dis Sci 2000;45:500-8. http://dx.doi.org/10.1023/A:1005437005811.
52. Pare P, Talbot J, Hoefs JC. Serum-ascites albumin concentration gradient: a physiologic approach to the differential diagnosis of ascites. Gastroenterology 1983;85:240-4.
53. Al-Knawy BA. Etiology of ascites and the diagnostic value of serum-ascites albumin gradient in non-alcoholic liver disease. Ann Saudi Med 1997;17:26-8.
54. Beg M, Hussain S, Ahmad N, Akhtar N. Serum/ascites albumin gradient in differential diagnosis of ascites. JIACM 2001;2:51-4.
55. Moore KP, Aithal GP. Guidelines on the management of as- cites in cirrhosis. Gut 2006;55(Suppl VI):vi1-vi12. http://dx.doi.org/10.1136/gut.2006.099580.
56. Hoefs JC. Globulin correction of the albumin gradient: correlation with measured serum to ascites colloid osmotic pressure gradients. Hepatology 1992;16:396-403. http://dx.doi.org/10.1002/hep.1840160218.
57. Jenkinson F, Murphy MJ. Biochemical analysis of pleural and ascitic fluid: effect of sample timing on interpretation of results. Ann Clin Biochem 2007;44:471-3. http://dx.doi.org/10.1258/000456307781645978.
58. Albillos A, Cuervas-Mons V, Millan I, Canton T, Montes J, Barrios C, et al. Ascitic fluid polymorphonuclear cell count and serum to ascites albumin gradient in the diagnosis of bacterial peritonitis. Gastroenterology 1990;98:134-40.
59. Rimola A, Garcia-Tsao G, Navasa M, Piddock LVJ, Planas R, Bernard B et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. J Hepatol 2000;32:142-53. http://dx.doi.org/10.1016/S0168-8278(00)80201-9.
60. Kim DY, Kim JH, Chon CY, Han K-H, Ahn SH, Kim JK, et al. Usefulness of urine strip test in the rapid diagnosis of spontaneous bacterial peritonitis. Liver International 2005;25:1197-201. http://dx.doi.org/10.1111/j.1478-3231.2005.01176.x.
61. Braga LLBC, Souza MHLP, Barbosa AMC, Furtado FM, Campelo PAM, Filho AHA. Diagnosis of spontaneous bacterial peritonitis in cirrhotic patients in north eastern Brazil by use of rapid urine-screening test. Sao Paulo Med J 2006;124:141-4. http://dx.doi.org/10.1590/S1516-31802006000300006.
62. Castellote J, Lopez C, Gornals J, Tremosa G, Rodriguez Farina E, Baliellas C, et al. Rapid diagnosis of spontaneous bacterial peritonitis by use of reagent strips. Hepatology 2003;37:893-96. http://dx.doi.org/10.1053/jhep.2003.50120.
63. Tuzun Y, Elik YC, Bayan K, Yilmaz S, Dursun M, Canoruc F. Correlation of tumor markers in ascitic fluid and serum: are measurements of ascitic tumor markers a futile attempt? J Int Med Res 2009;37:79-86. http://dx.doi.org/10.1177/147323000903700109.
64. Karcher DS, McPherson RA. Cerebrospinal, synovial, serous body fluids and alternative specimens. In: McPherson RA, Pincus MR, eds. Henry's clinical diagnosis and management by laboratory methods [Electronic version]. Philadelphia: Elsevier/Saunders; 2011. p.480-510. Available at: http://www.mdconsult.com/books. Accessed November 11th 2013.
65. Van der Gaag NA, Verhaar AC, Haverkort EB, Busch ORC, van Gulik TM, Gouma DJ. Chylous ascites after pancreaticoduodenectomy: introduction of grading system. J Am Coll Surg 2008;207:751-7. http://dx.doi.org/10.1016/j.jamcollsurg.2008.07.007.
66. Tulunay G, Ureyen I, Turan T, Karalok A, Kavak D, Ozgul N, et al. Chylous ascites: analysis of 24 patients. Gynecol Oncol 2012;127:191-7. http://dx.doi.org/10.1016/j.ygyno.2012.06.023.
67. Riquelme A, Calvo M, Salech F, Valderrama S, Pattillo A, Arellano M, et al. Value of adenosine deaminase (ADA) in ascitic fluid for the diagnosis of tuberculous peritonitis. A metaanalysis. J Clin Gastroenterol 2006;40:705-10. http://dx.doi.org/10.1097/00004836-200609000-00009.
68. Dennebaum R. Pericardial effusion. In: Thomas L, ed. Clinical laboratory diagnostics: use and assessment of clinical laboratory results. Frankfurt/Mein: TH Books;1998. p.1348-56.
69. Meyers DG, Meyers RE, Prendergast TW. The usefulness of diagnostic tests on pericardial fluid. Chest 1997;111:1213-21. http://dx.doi.org/10.1378/chest.111.5.1213.
70. Burgess LJ, Reuter H, Frans Taljaard JJ, Doubell AF. Role of biochemical tests in the diagnosis of large pericardial effusions. Chest 2002;121:495-9. http://dx.doi.org/10.1378/chest.121.2.495.
71. Ben-Horin S, Shinfeld A, Kachel E, Chetrit A, Livneh A. The composition of normal pericardial fluid and its implications for diagnosing pericardial effusions. Am J Med 2005;118:636-40. http://dx.doi.org/10.1016/j.amjmed.2005.01.066.
72. Ben-Horin S, Bank I, Shinfeld A, Kachel E, Guetta V, Livneh A. Diagnostic value of the biochemical composition of pericardial effusions in patients undergoing pericardiocentesis. Am J Cardiol 2007;99:1294-7. http://dx.doi.org/10.1016/j.amjcard.2006.12.048.
73. Cale-Subia LN, de Luna AM. Applicability of Light's criteria in the biochemical analysis of pericardial fluid. Phil Heart Center J 2012;16:50-4.
74. Tuon FF, Nobrega Litvoc M, Ferreira Lopes MIB. Adenosine deaminase and tuberculous pericarditis - a systematic review with meta-analysis. Acta Tropica 2006;99:67-74. http://dx.doi.org/10.1016/j.actatropica.2006.07.004.
75. Calgary Laboratory Services. Body fluid collection guidelines. Available at: http://www.calgarylabservices.com/education-research/medical-professionals-education. Accessed November 4th 2013.
76. Cheng D, Rodriguez M, Rogers J, Wagster M, Starnes DL, Light RW. Comparison of pleural fluid pH values obtained using blood gas machine, pH meter, and pH indicator strip. Chest 1998;114:1368-72. http://dx.doi.org/10.1378/ chest.114.5.1368.