“Efficacy of Total Pleural Fluid Bilirubin And Ratio to Serum Levels, Pleural Fluid Cholesterol And Total Protein Level in Diagnosing Pleural Effusion Exudates And Transudates And Its Correlation with light’s Criteria”

Objectives: To evaluate the usefulness of Total Pleural fluid Bilirubin and its ratio to serum Bilirubin levels, Pleural fluid Cholesterol and Pleural fluid Total Protein level in classifying pleural effusions as exudates and transudates.Methods: This study was conducted among 50 Patients with clinical and radiological evidence of pleural effusion.Then they are classified into exudates and transudates on the basis of the clinical, radiological and biochemical evaluation.Pleural fluid LDH, bilirubin, protein, cholesterol & Serum LDH, protein, Bilirubin were estimated and classified into exudates or transudates.Sensitivity, specificity, Positive predictive value , negative predictive value , diagnostic accuracy of each tests were calculated.Results: From our study we came to know that there was no statistically significant difference among various criteria in classifying pleural effusion as exudates and transudates.The misclassification of exudates and transudates by various criteria when compared to Light's criteria was not statistically significant as p value<0.05.Conclusion: From our study we came to a conclusion that to classify exudative and transudativepleural effusion, the most specific test is pleural fluid total protein andthemost sensitive test is pleural fluid / serum bilirubin ratio.To conclude, though Light's criteria remains as gold standard to differentiate transudates and exudates, in cases where there is a mismatch between clinical diagnosis and the outcome from Light's criteria, pleural fluid bilirubin / serum bilirubin ratio and pleural fluid total protein evaluation may add to the diagnostic accuracy.