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The Egyptian Journal of Bronchology
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  • Pleural diseases
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The diagnostic utility of pleural fluid viscosity in lymphocytic pleural effusion

Egyptian Journal of Bronchology volume 9, pages 73–78 (2015)Cite this article

Abstract

Context

The first step in the diagnostic work up of pleural effusion is the distinction between transudative and exudative pleural effusions (TPEs and EPEs). This discrimination is based on some biochemical tests that are relatively costly and time consuming. Lymphocyte-predominant EPE is the result of many diseases with malignancy, tuberculosis being the most common among them.

Aims

The aim of this study was to assess the role of pleural fluid viscosity in the differentiation between exudates and transudates and to identify the cause of pleural effusion.

Patients and methods

The study comprised 10 patients with TPE and 48 patients with EPE: 18 of them had tuberculous (TB) effusion, 25 patients had malignant pleural effusion (MPE) (patients with MPE included 10 with lung cancer and 15 with other known or unknown cancers) and five patients had connective tissue disease (CTD)-associated effusion. Pleural fluid protein, albumin, lactic dehydrogenase, and viscosity were measured in all patients.

Results

Pleural fluid viscosity was higher in patients with EPE with a highly significant difference (P < 0.01), and a cutoff value of 1.01 cP could distinguish between TPE and EPE with a sensitivity of 97.7%, a specificity of 93.9%, a positive predictive value of 97.5%, and a negative predictive value of 92.5%. It also showed significant positive correlation with protein, albumin, and lactic dehydrogenase. It was also higher in TB effusion than in MPE, with a highly significant difference (P < 0.01), and in CTD-associated effusion with a significant difference (P < 0.05). At a cutoff value of 1.5 cP, pleural fluid viscosity could discriminate between TB effusion and MPE with a sensitivity of 67%, a specificity of 84%, a positive predictive value of 75%, and a negative predictive value of 77%. There was also a nonsignificant difference between MPE secondary to lung cancer versus other known or unknown primary cancer (P > 0.05).

Conclusion

Pleural fluid viscosity can reliably differentiate between TPE and EPE. It can also help in the discrimination between TB effusion and MPE with moderate sensitivity and high specificity.

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Authors and Affiliations

  1. Chest Unit, Internal Medicine Department, Suez Canal University, Ismailia, 204, Egypt

    Sayed Labiba MD & Eman Riad

  2. Clinical Pathology Department, Suez Canal University, Ismailia, Egypt

    Basma B. Hasan

  3. Chest Department, Ain Shams University, Cairo, Egypt

    Ibraheem Dwidar

Authors
  1. Sayed Labiba MD
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  2. Ibraheem Dwidar
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  3. Eman Riad
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  4. Basma B. Hasan
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Correspondence to Sayed Labiba MD.

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Labiba, S., Dwidar, I., Riad, E. et al. The diagnostic utility of pleural fluid viscosity in lymphocytic pleural effusion. Egypt J Bronchol 9, 73–78 (2015). https://doi.org/10.4103/1687-8426.153656

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  • DOI: https://doi.org/10.4103/1687-8426.153656

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