Pleural effusion – cytological-energy analysis versus traditional Light’s criteria
Authors:
I. Matuchová 1,2,3; P. Kelbich 1,2,3; J. Kubalík 2,4; I. Staněk 4; J. Špička 5; V. Malý 4; O. Karpjuk 4; E. Hanuljaková 1,3; J. Krejsek 2
Authors‘ workplace:
Biomedicínské centrum, Krajská zdravotní, a. s. - Masarykova nemocnice v Ústí nad Labem, o. z.
1; Ústav klinické imunologie a alergologie, LF UK v Hradci Králové a FN v Hradci Králové
2; Laboratoř pro likvorologii, neuroimunologii, patologii a speciální diagnostiku Topelex, s. r. o.
3; Oddělení hrudní chirurgie, Krajská zdravotní, a. s. - Masarykova nemocnice v Ústí nad Labem, o. z.
4; Oddělení klinické biochemie, Krajská zdravotní, a. s. - Masarykova nemocnice v Ústí nad Labem, o. z.
5
Published in:
Klin. Biochem. Metab., 29, 2021, No. 4, p. 190-198
Overview
Objective: Comparison of diagnostic efficiency of Light’s parameters with cytological-energy analysis parameters of pleural effusion.
Design: retrospective.
Settings: Biomedical Centre, Krajská zdravotní, a. s. - Masaryk Hospital in Ústí nad Labem, o. z.; Department of Clinical Immunology and Allergology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University in Prague; Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics Topelex, s.r.o; Department of Thoracic Surgery, Krajská zdravotní, a.s. - Masaryk Hospital in Usti nad Labem, o.z.; Department of Clinical Biochemistry, Krajská zdravotní, a.s. – Masaryk Hospital in Ústí nad Labem, o.z.
Material and Methods: The 96 samples of noninflammatory pleural effusions of patients with cardiac failure or systemic sepsis, the 211 samples of pleural effusions of patients with purulent pneumonia and the 283 samples of pleural effusions of patients with chest empyema were analysed. In all cases, we analysed selected parameters of Light criteria (total number of nuclear elements in 1 µl, concentration of total protein, glucose, lactate and catalytic activity of lactate dehydrogenase (LDH)) and parameters of cytological-energy analysis (frequency of neutrophils, KEB value and catalytic activity of aspartate aminotransferase (AST)). Statistical analysis was performed using the ANOVA Kruskal-Wallis test and ROC-analysis.
Results: We found significant differences of parameters of Light‘s criteria and cytological-energy analysis between inflammatory and noninflammatory pleural effusions (p < 0.01). We found significant differences between patients with purulent pneumonia and chest empyema (p < 0.01). Light’s criteria parameters included total number of nuclear elements, concentration of total protein, lactate and catalytic activities of LDH. Cytological-energy parameters included KEB value and catalytic activities of AST.
We found high diagnostic accuracy of ,,Light’s‘‘ concentration of glucose (AUC = 0.981), lactate (AUC = 0.970) and catalytic activities of LDH (AUC = 0.962) and ,,cytological-energy‘‘ frequency of neutrophils (AUC = 0.982), KEB values (AUC = 0.999) and catalytic activities of AST (AUC = 0.954) to distinguish between noninflammatory and parapneumonic pleural effusions.
We found high diagnostic accuracy of „Light’s“ total number of nuclear elements (AUC = 0.939), concentration of glucose (AUC = 0.967), lactate (AUC = 0.987) and catalytic activities of LDH (AUC = 0.984) and ,,cytological-energy‘‘ frequency of neutrophils (AUC = 0.985), KEB values (AUC = 0.991) and catalytic activities of AST (AUC = 0.979) to distinguish between noninflammatory pleural effusions and pleural effusions of patients with chest empyema.
We found low diagnostic accuracy of all parameters to distinguish parapneumonic effusion and pleural effusion of patients with chest empyema: „Light’s“ total number nuclear elements (AUC = 0.714), concentration of glucose (AUC = 0.631), lactate (AUC = 0.721), total protein (AUC = 0.537) and catalytic activities of LDH (AUC = 0.710) and „cytological-energy‘‘ frequency of neutrophils (AUC = 0.553), KEB values (AUC = 0.671) and catalytic activities of AST (AUC = 0.718).
Conclusion: The advantage of cytological-energy analysis versus Light’s criteria parameters is in their abilities to characterize a local immune response considering the energy state. Both methods complement each other appropriately. In any case, they do not contradict each other.
Keywords:
Pleural effusion – pneumonia – empyema – Light’s criteria – cytological-energy analysis – coefficient of energy balance
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