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Lactate determination in pleural and abdominal effusions: a quick diagnostic marker of exudate—a pilot study
- Publication Year :
- 2018
-
Abstract
- Pleural or abdominal effusions are frequent findings in ICU and Internal Medicine patients. Diagnostic gold standard to distinguish between transudate and exudate is represented by “Light’s Criteria,” but, unfortunately, the chemical–physical examination for their calculation is not a rapid test. Pursuing an acid–base assessment of the fluid by a blood-gas analyzer, an increase of lactate beyond the normal serum range is reported in the exudative effusions. The advantages of this test are that it is a very fast bed-side test, executable directly by the physician. The aim of this study is to evaluate whether the increase in lactate in pleural and abdominal effusions might be used as a criterion for the differential diagnosis of the nature of the fluid. Sixty-nine patients with pleural or abdominal effusions and clinical indication for thoracentesis or paracentesis were enrolled. Acid–base assessment with lactate, total protein, and LDH dosage on the serum, and acid–base assessment with lactate, total protein, and LDH dosage, cytology, and bacterial culture on the fluid were performed to each patient. Fluid–blood lactate difference (ΔLacFB) and fluid–blood lactate ratio (LacFB ratio) were calculated. A statistical analysis was carried out for fluid lactate (LacF), ΔLacFB, and LacFB ratio, performing ROC curves to find the cut-off values with best sensitivity (Sn) and specificity (Sp) predicting an exudate diagnosis: LacF: cut-off value: 2.4mmol/L; AU-ROC 0.854 95% CI 0.756–0.952; Sn 0.77; Sp 0.84. ΔLacFB: cut-off value: 0.95mmol/L; Au-ROC 0.876 95% CI 0.785–0.966; Sn 0.80; Sp 0.92. LacFB ratio: cut-off value: 2mmol/L; Au-ROC 0.730 95% CI 0.609–0.851; Sn 0.74; Sp 0.65. Lactate dosage by blood-gas analyzer on pleural and abdominal effusions seems to be a promising tool to predict a diagnosis of exudate.
- Subjects :
- Male
Pathology
Microbiological culture
Pleural effusion
medicine.medical_treatment
Thoracentesis
Pilot Projects
Lactate ratio
Predictive Value of Test
Gastroenterology
Transudate
Bacterial peritonitis
0302 clinical medicine
Paracentesis
Ascitic Fluid
030212 general & internal medicine
Diagnostic Techniques and Procedures
Aged, 80 and over
medicine.diagnostic_test
Exudates and Transudates
Middle Aged
Exudates and Transudate
Bacterial peritoniti
Delta lactate
Area Under Curve
Emergency Medicine
Female
Infection
Human
medicine.medical_specialty
Exudate
Sepsi
Sepsis
03 medical and health sciences
Predictive Value of Tests
Internal medicine
Internal Medicine
medicine
Humans
Diagnostic marker
Abdominal effusion
Pilot Project
Lactic Acid
Thoracentesi
Paracentesi
Aged
business.industry
Lactate
Light’s criteria
Pneumonia
Gold standard (test)
Biomarker
medicine.disease
Diagnostic Techniques and Procedure
030228 respiratory system
ROC Curve
Differential diagnosis
business
Biomarkers
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....67175becb32ac41ceaa13ab35d2f4520