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Diagnostic value of tests that discriminate between exudative and transudative pleural effusions Primary Study Investigators Heffner JE; Brown LK; Barbieri CAChest 1997[Apr]; 111 (4): 970-80STUDY OBJECTIVE: To (1) determine appropriate decision thresholds and diagnostic accuracies for pleural fluid (PF) tests that discriminate between exudative and transudative pleural effusions, and (2) evaluate the quality of the primary investigations. DESIGN: Formal meta-analysis of studies that report the diagnostic value of pleural fluid tests. SETTING: Data collected from international academic medical centers. PATIENTS: Hospitalized patients undergoing thoracentesis for pleural effusions. INTERVENTIONS: Primary investigators were requested to transmit original data from patients described in their studies. MEASUREMENTS AND RESULTS: Eight primary studies described 1,448 patients with one or more of the following tests: protein (P)-PF, P-PF/serum ratio (R), bilirubin (BILI)-R, lactate dehydrogenase (LDH)-PF, LDH-R, cholesterol (C)-PF, C-R, and albumin gradient. We found that all eight tests had similar diagnostic accuracies when evaluated by receiver operating characteristic (ROC) analysis except for BILI-R, which was less diagnostically accurate. Decision thresholds determined by ROC analysis differed from previously reported values for LDH-PF (>0.45 upper limits of normal) and C-PF (>45 mg/dL). Paired and triplet test combinations tended to have higher diagnostic accuracies compared with individual tests, but examination of the odds ratios with 95% confidence intervals did not identify a clearly superior test combination. Limitations of the primary studies presented a high likelihood of bias affecting their results. CONCLUSIONS: Several strategies exist for clinicians in utilizing PF tests to classify effusions as exudates or transudates but accurate interpretations of these test results will require better designed studies.|Albumins/analysis[MESH]|Bilirubin/analysis[MESH]|Cholesterol/analysis[MESH]|Exudates and Transudates/*chemistry[MESH]|Female[MESH]|Humans[MESH]|L-Lactate Dehydrogenase/analysis[MESH]|Male[MESH]|Middle Aged[MESH]|Pleural Effusion/*chemistry[MESH]|Proteins/analysis[MESH]|ROC Curve[MESH]|Sensitivity and Specificity[MESH] |
