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. 2013 Jun;143(6):1709-1716.
doi: 10.1378/chest.12-2221.

Effects of coexisting pneumonia and end-stage renal disease on pleural fluid analysis in patients with hydrostatic pleural effusion

Peter Doelken  1 , John T Huggins  2 , Mark Goldblatt  3 , Paul Nietert  4 , Steven A Sahn  2
Affiliations

Effects of coexisting pneumonia and end-stage renal disease on pleural fluid analysis in patients with hydrostatic pleural effusion

Peter Doelken et al. Chest. 2013 Jun.

Abstract

Background: In individual patients, especially those who are hospitalized, several conditions often coexist that may be responsible for the development of a pleural effusion and may affect the pleural fluid analysis (PFA). The objective of this study was to investigate the effects of end-stage renal disease and pneumonia on PFA in patients with hydrostatic pleural effusion.

Methods: In a retrospective analysis of 1,064 consecutive patients who underwent thoracentesis at a university hospital, cell counts and pleural fluid protein, lactate dehydrogenase, pH, and glucose levels were examined in those (n = 300) with clinical evidence of hydrostatic pleural effusion.

Results: The 300 patients (28.1%) with pleural effusions had congestive heart failure (CHF), circulatory overload (CO), or both. Expert consensus was achieved in 66 (22%) for CHF as the sole diagnosis (SCHF), 30 (10%) for CHF and coexisting pneumonia (PCHF), and 26 (8.7%) for end-stage renal disease (ESRD) with coexisting CO or CHF. The remaining 178 patients were excluded because of complicating conditions. There were minor, but statistically significant differences in pleural fluid/serum protein ratios in patients with ESRD with coexisting CO or CHF compared with SCHF. Compared with SCHF, there were statistically significant tendencies for higher protein and lactate dehydrogenase concentrations and lower pH levels in those with PCHF. The total nucleated cell count and the absolute neutrophil count were significantly higher in PCHF.

Conclusions: ESRD in patients with hydrostatic pleural effusions has a minimal effect on the PFA. Coexisting pneumonia most often results in an exudative effusion in patients with CHF.

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Figures

Figure 1.
Figure 1.
Flowchart describing the selection of patients (n = 1,064). CHF = congestive heart failure; ESRD = end-stage renal disease; ESRDCOCHF = end-stage renal disease with coexisting circulatory overload or congestive heart failure; PCHF = congestive heart failure and coexisting pneumonia; SCHF = congestive heart failure as the sole diagnosis.
Figure 2.
Figure 2.
Comparison of pleural fluid protein/serum protein ratio and LDH in patients with SCHF, ESRD with hydrostatic pleural effusions, and PCHF. The box represents the interquartile range, the line within the box represents the median, bars represent the 5% to 95%, the dots represent outliers, and the dotted line represents the cut point for exudative vs transudative effusions whereby above the dotted line is exudative. *P value comparing SCHF with ESRDCOCHF; **P value comparing SCHF with PCHF. LDH = lactate dehydrogenase. See Figure 1 legend for expansion of other abbreviations.
Figure 3.
Figure 3.
Comparison of pleural fluid pH and pleural fluid glucose levels in patients with SCHF, ESRD with hydrostatic pleural effusions, and PCHF. The box represents the interquartile range, the line within the box represents the median, bars represent the 5% to 95%, and the dots represent outliers. *P value comparing SCHF with ESRDCOCHF; **P value comparing SCHF with PCHF. See Figure 1 legend for expansion of abbreviations.
Figure 4.
Figure 4.
Comparison of pleural fluid total nucleated cell count (cells/μL) and pleural fluid absolute neutrophil count (cells/μL) in patients with SCHF, ESRD with hydrostatic pleural effusions, and PCHF. The box represents the interquartile range, the line within the box represents the median, bars represent the 5% to 95%, and the dots represent outliers. *P value comparing SCHF with ESRDCOCHF; **P value comparing SCHF with PCHF. See Figure 1 legend for expansion of abbreviations.
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References

    1. Eid AA, Keddissi JI, Samaha M, Tawk MM, Kimmell K, Kinasewitz GT. Exudative effusions in congestive heart failure. Chest. 2002;122(5):1518-1523 - PubMed
    1. Noppen M, De Waele M, Li R, et al. Volume and cellular content of normal pleural fluid in humans examined by pleural lavage. Am J Respir Crit Care Med. 2000;162(3 pt 1):1023-1026 - PubMed
    1. Porcel JM. Establishing a diagnosis of pleural effusion due to heart failure. Respirology. 2009;14(4):471-473 - PubMed
    1. Pillay VK. Total proteins in serous fluids in cardiac failure. S Afr Med J. 1965;39:142-143 - PubMed
    1. Peterman TA, Brothers SK. Pleural effusions in congestive heart failure and in pericardial disease. N Engl J Med. 1983;309(5):313. - PubMed

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