Back to Search
Start Over
Lactate determination in pleural and abdominal effusions: a quick diagnostic marker of exudate-a pilot study.
- Source :
-
Internal and emergency medicine [Intern Emerg Med] 2018 Sep; Vol. 13 (6), pp. 901-906. Date of Electronic Publication: 2017 Sep 30. - 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: 2.4 mmol/L; AU-ROC 0.854 95% CI 0.756-0.952; Sn 0.77; Sp 0.84. ΔLacFB: cut-off value: 0.95 mmol/L; Au-ROC 0.876 95% CI 0.785-0.966; Sn 0.80; Sp 0.92. LacFB ratio: cut-off value: 2 mmol/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 :
- Aged
Aged, 80 and over
Area Under Curve
Biomarkers analysis
Biomarkers blood
Diagnostic Techniques and Procedures
Exudates and Transudates chemistry
Female
Humans
Lactic Acid blood
Male
Middle Aged
Pilot Projects
Pleural Effusion diagnosis
Predictive Value of Tests
ROC Curve
Ascitic Fluid chemistry
Lactic Acid analysis
Pleural Effusion chemically induced
Subjects
Details
- Language :
- English
- ISSN :
- 1970-9366
- Volume :
- 13
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Internal and emergency medicine
- Publication Type :
- Academic Journal
- Accession number :
- 28965174
- Full Text :
- https://doi.org/10.1007/s11739-017-1757-y