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1.
Clin Lab ; 67(10)2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34655195

RESUMO

BACKGROUND: Currently, there are few studies on the correlation between platelet counts (PLT), plateletcrit (PCT), and platelet-to-lymphocyte ratio (PLR) in small cell lung carcinoma (SCLC) with and without pleural effusion. This study is to investigate their likely correlation and to evaluate the potential diagnostic or prognostic applications of these platelet parameters. METHODS: A total of 218 each of patients with primary SCLC and healthy controls were included. Hematological indicators and other clinically relevant information were collected. Comparisons of the differences between groups were applied to the independent samples t-test or the chi-squared test. ROC curve analysis was used to access the diagnostic performance of PLT, PCT, and PLR. RESULTS: Compared with healthy controls, PLT, PCT, and PLR in SCLC were significantly higher. On the other hand, mean platelet volume, lymphocytes, and hemoglobin were significantly lower. The levels of PLT, PCT, and PLR were related to malignant pleural effusion, while not related to lymph node or distant metastasis. The incidence of pleural effusion in patients with SCLC was positively correlated with the levels of PLT, PCT, and PLR. ROC curve analysis showed that PLT, PCT, and PLR were valuable markers for SCLC, and the combination of the three has higher diagnostic efficacy. CONCLUSIONS: Platelet parameters were significantly different between SCLC and controls. PLT, PCT, and PLR could be used to assess the presence of pleural effusion.


Assuntos
Neoplasias Pulmonares , Derrame Pleural , Carcinoma de Pequenas Células do Pulmão , Plaquetas , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Linfócitos , Volume Plaquetário Médio , Contagem de Plaquetas , Derrame Pleural/diagnóstico , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/complicações , Carcinoma de Pequenas Células do Pulmão/diagnóstico
4.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 52(5): 855-858, 2021 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-34622605

RESUMO

Objective: To investigate the clinical features of pediatric patients who had plastic bronchitis (PB) and to explore the risk factors for respiratory support in the pediatric patients with PB in order to improve the ability to identify PB in children. Methods: The basic information and clinical manifestations of 86 children diagnosed with PB at West China Second University Hospital of Sichuan University from March 2014 to December 2019 were collected and analyzed retrospectively. The patients were divided into the respiratory support (RS) group and non-respiratory support (NRS) group as per their need for respiratory support. Logistic regression was conducted to analyze the risk factors for respiratory support in PB patients. Results: A total of 86 children with PB were included in the study, including 62 (72.1%) who were over 3 years old. 57 patients (66.3%) had complications. 56 patients were given respiratory support after admission. All the 86 children had a history of fever and cough, and 76 (88.4%) experienced fever peaks≥39.5°C. Chest imaging showed large lung consolidation or atelectasis in 82 cases (95.3%) and pleural effusion in 63 cases (73.3%). 70 cases (81.4%) were tested positive for pathogens, with the highest infection rate of 68.6% for mycoplasma pneumoniae. There were 30 patients (34.9%) in the NRS group and 56 patients (65.1%) in the RS group. Logistic regression analysis showed that patient being younger than 3 years old ( OR=4.99) and having complications ( OR=7.22) were independent risk factors for respiratory support in children with PB (all P<0.05). Conclusions: Clinically, severe clinical symptoms combined with other systemic complications, large lung consolidation or atelectasis, pleural effusion, and positive lab results for mycoplasma pneumoniae should be an alert indicating the possibility of having PB. Young age and complications were independent risk factors for respiratory support in PB patients.


Assuntos
Bronquite , Derrame Pleural , Bronquite/epidemiologia , Criança , Pré-Escolar , Humanos , Mycoplasma pneumoniae , Plásticos , Estudos Retrospectivos
5.
Am J Case Rep ; 22: e933396, 2021 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-34606491

RESUMO

BACKGROUND As use of immune checkpoint inhibitors consistently grows, so does knowledge of immune-related adverse events. Pleural complications from PD-L1 inhibitors such as atezolizumab have never been reported. We describe the first reported case of biopsy-proven pleuritis manifesting as recurrent pleural effusion in a patient treated with atezolizumab. CASE REPORT A 66-year-old woman with history of extensive-stage small cell lung cancer presented with a new pleural effusion. She was previously treated with carboplatin, etoposide, and atezolizumab followed by atezolizumab maintenance, but this later was stopped due to pneumonitis. She had been on no systemic therapy for 6 months prior; radiation to the chest was completed 1 year earlier. Thoracentesis revealed an exudate with eosinophilia but no malignancy. She underwent medical thoracoscopy, which showed normal pleura with no evidence of radiation changes. Random pleural biopsies revealed only chronic pleuritis. Given normal-appearing pleura, radiation pleuritis was ruled out. It was felt that the chemotherapy had occurred too long ago to be a present cause of her pleuritis. As such, after extensive workup, the eosinophilic pleural effusion was felt to be due to pleuritis from atezolizumab. The effusion has ultimately recurred 5 times over 1 year, and cytology remains negative for malignancy. CONCLUSIONS Patients with prior cancer presenting with a new pleural effusion should undergo an extensive workup to evaluate for recurrence. When other causes have been ruled out, ongoing immune-related effects of immunotherapy should be considered. Pleural complications from PD-L1 inhibitors have not been reported; we present a possible case of chronic pleuritis and recurrent effusion due to atezolizumab.


Assuntos
Neoplasias Pulmonares , Derrame Pleural , Pleurisia , Carcinoma de Pequenas Células do Pulmão , Idoso , Anticorpos Monoclonais Humanizados , Exsudatos e Transudatos , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Derrame Pleural/induzido quimicamente , Pleurisia/induzido quimicamente
6.
Clin Med (Lond) ; 21(5): e531-e532, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34507940

RESUMO

We present a case of black pleural fluid following thoracic trauma. The unusual dark colour most strikingly resembled soy sauce as independently commented upon by multiple treating physicians. The black colouration could not be fully accounted for by haemothorax or cholethorax, so other differential diagnoses were investigated, including Aspergillus niger infection and malignant melanoma. The cause, however, was thought to be due to staining of the fluid with carbon deposited in the pleural space from the non-volatilised impurities from smoking crack cocaine. A novel use of a point-of-care urine toxicology assay confirmed the presence of cocaine in the pleural fluid. Considering a broad range of differential diagnoses is needed to avoid missing important causes of unusual pleural effusions.


Assuntos
Melanoma , Derrame Pleural , Neoplasias Cutâneas , Alimentos de Soja , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Derrame Pleural/diagnóstico por imagem
7.
Medicine (Baltimore) ; 100(38): e22571, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34559092

RESUMO

BACKGROUND: There are few reports on the chest computed tomography (CT) imaging features of children with coronavirus disease 2019 (COVID-19), and most reports involve small sample sizes. OBJECTIVES: To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice. DATA SOURCES: We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu. METHODS: Reports on chest CT imaging features of children with COVID-19 from January 1, 2020 to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software. RESULTS: Thirty-seven articles (1747 children) were included in this study. The heterogeneity of meta-analysis results ranged from 0% to 90.5%. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8%-70.6%), with a rate of 61.0% (95% CI: 50.8%-71.2%) in China and 67.8% (95% CI: 57.1%-78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7%-48.3%), multiple lung lobe lesions was 65.1% (95% CI: 55.1%-67.9%), and bilateral lung lesions was 61.5% (95% CI: 58.8%-72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported 3 cases of white lung, another reported 2 cases of pneumothorax, and another 1 case of bullae. CONCLUSIONS: The lung CT results of children with COVID-19 are usually normal or slightly atypical. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool.


Assuntos
COVID-19/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Vesícula/diagnóstico por imagem , Vesícula/epidemiologia , Vesícula/virologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Criança , Pré-Escolar , Gerenciamento de Dados , Feminino , Humanos , Incidência , Lactente , Pulmão/patologia , Pulmão/virologia , Masculino , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/epidemiologia , Derrame Pleural/virologia , Pneumotórax/diagnóstico por imagem , Pneumotórax/epidemiologia , Estudos Retrospectivos , SARS-CoV-2/genética , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/epidemiologia , Nódulo Pulmonar Solitário/virologia , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/tendências
8.
BMJ Case Rep ; 14(9)2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544724

RESUMO

We report a case of a 74-year-old male patient who was referred to the respiratory clinic with an incidental finding of a left sided pleural effusion. He was initially being treated by the general practitioner for chest infection with productive cough that had limited resolution after course of oral antibiotics. At the pleural clinic, 1.5 L of serosanguineous fluid was drained and sent for diagnostics. However, the diagnosis only reached as far as idiopathic exudative effusion with lymphocytes and plasma cells. He was then referred for video-assisted thoracoscopic surgery pleural biopsy and pleurodesis. It revealed black pleura with abundant IgG4 positive cells. He is followed up in respiratory clinic where further discussion and treatment has commenced.


Assuntos
Derrame Pleural , Idoso , Exsudatos e Transudatos , Humanos , Masculino , Pleura/diagnóstico por imagem , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Pleurodese , Cirurgia Torácica Vídeoassistida
9.
BMJ Case Rep ; 14(9)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518185

RESUMO

COVID-19 has a broad spectrum of cardiac manifestations, and cardiac tamponade leading to cardiogenic shock is a rare presentation. A 30-year-old man with a history of COVID-19-positive, reverse transcription polymerase chain reaction (RT-PCR) done 1 week ago and who was home-quarantined, came to the emergency department with palpitations, breathlessness and orthopnoea. His ECG showed sinus tachycardia with low-voltage complexes, chest X-ray showed cardiomegaly and left pleural effusion and two-dimensional echocardiography showed large pericardial effusion with features suggestive of cardiac tamponade. He was taken up for emergency pericardiocentesis which showed haemorrhagic pericardial fluid. Intercostal drainage insertion was done for left-sided large pleural effusion. After ruling out all the other causes for haemorrhagic pericardial effusion, the patient was started on colchicine, steroids, ibuprofen and antibiotics to which he responded. Both pericardial and pleural effusions resolved completely on follow-up.


Assuntos
COVID-19 , Tamponamento Cardíaco , Derrame Pleural , Adulto , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Humanos , Masculino , Pericardiocentese , Pericárdio , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , SARS-CoV-2
10.
BMJ Case Rep ; 14(9)2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34588205

RESUMO

Neonatal chylothorax is a rare presentation leading to significant respiratory distress, thus requiring timely diagnosis. A preterm neonate was resuscitated and ventilated, following which she clinically improved but subsequently developed respiratory distress with a right-sided pleural effusion. Interestingly, thoracentesis fluid appeared 'milky' with elevated triglycerides and lymphocytes, suggesting chylothorax. As fluid triglyceride level was lower than the established diagnostic criterion for chylothorax (1.24 mmol/L), a high fluid-to-serum triglyceride ratio was used as a surrogate diagnostic marker, later confirmed by lipoprotein electrophoresis. As observed in the index patient, a critically ill neonate would have a lower-than-average fat intake leading to less chylomicron production, thus lower triglyceride levels in chyle than expected, which may still fail to meet the amended cut-off limit. This case highlights the challenges in diagnosing neonatal chylothorax due to the lack of age-specific triglyceride levels in chyle and low oral fat intake in critically ill patients.


Assuntos
Quilo , Quilotórax , Derrame Pleural , Quilotórax/diagnóstico , Quilotórax/etiologia , Dieta com Restrição de Gorduras , Exsudatos e Transudatos , Feminino , Humanos , Recém-Nascido , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia
11.
BMJ Case Rep ; 14(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479888

RESUMO

Nilotinib is used as standard treatment in managing chronic myeloid leukaemia (CML). A 23-year-old man with CML and on nilotinib was admitted to the intensive care unit due to respiratory failure. Three years prior, he developed pleural effusion from dasatinib therapy thus, his CML regimen was changed to nilotinib. Although the pleural effusion had once improved, the chest imaging revealed left-dominant bilateral pleural effusion. Endotracheal intubation and left thoracic drainage were performed. Nilotinib treatment was discontinued, and approximately 60 hours later, nilotinib concentrations of 927 and 2092 ng/mL were determined in his blood and pleural effusion, respectively. Severe pleural effusion may be induced in patients administering nilotinib, and nilotinib concentrations in blood and pleural effusion can be elevated in patients with nilotinib-related pleural effusion. Cross-occurrence of pleural effusions needs to be monitored precisely, especially in patients who are switched to other tyrosine kinase inhibitors after dasatinib treatment.


Assuntos
Antineoplásicos , Leucemia Mielogênica Crônica BCR-ABL Positiva , Derrame Pleural , Adulto , Antineoplásicos/efeitos adversos , Dasatinibe/efeitos adversos , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Masculino , Derrame Pleural/induzido quimicamente , Inibidores de Proteínas Quinases/efeitos adversos , Pirimidinas , Adulto Jovem
12.
Clin Lab ; 67(9)2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34542971

RESUMO

BACKGROUND: The aim was to probe the association of pleural effusion with lung infection in patients with liver transplantation and to provide a theoretical foundation for preventing, diagnosing, and remedying pulmonary complications after liver transplantation. METHODS: Our team harvested clinical data of patients undergoing orthotopic allogeneic liver transplantation complicated with pleural effusion after surgery in our institution from May 2018 to July 2019. Based on whether puncture drainage was needed, patients were allocated to either control group or observation group. The differences in pleural effusion depth, lung function, lung infection, serum inflammatory factor levels and 6-month survival before and after surgery were compared. Finally, ROC curves were constructed for dissecting the correlation of pleural effusion with lung infection. RESULTS: On day 3 after surgery, (1) pleural effusion depth of the observation group was 5.70 ± 1.20 cm, which was saliently greater than that of control group (p < 0.05); (2) in comparison to control group, lung function indexes FVC, FEV1.0, MVV, and PaO2 of observation group declined (all p < 0.05); (3) sputum culture evinced that the lung infection rates of the control group and observation group were 17.24% and 71.70%, respectively, and the observation group harbored brilliantly higher infection rate (p < 0.05); (4) in comparison to the control group, IL-6, IL-8, and TNF-α in observation group were increased (p < 0.05); (5) AUC of pleural effusion depth and lung infection was 0.849, 0.805, and 0.853, respectively on days 1, 2, and 3 after surgery. CONCLUSIONS: A positive correlation existed between pleural effusion and lung infection after liver transplantation. When patients have persistent pleural effusion, the incidence of lung infection should be prevented and reduced.


Assuntos
Transplante de Fígado , Derrame Pleural , Pneumonia , Drenagem , Humanos , Transplante de Fígado/efeitos adversos , Pulmão , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia
13.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(8): 920-924, 2021 Aug 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34565740

RESUMO

Pasteurella multocida empyema is rare and easy to be misdiagnosed. An 81-year-old male patient showed symptoms with cough, sputum, and fever for 3 days. Community-acquired pneumonia was diagnosed firstly. After anti-infection treatment, the patient was still in fever. Chest radiography showed pleural effusion, closed thoracic drainage was performed and the reddish-brown fluid was drained out. The second-generation sequencing was performed on pleural fluid and Pasteurella multocida was detected. Pasteurella multocida has strict requirements for growth conditions and it difficult to cultivate. The application of second-generation sequencing is helpful to diagnose the pathogen rapidly.


Assuntos
Empiema , Infecções por Pasteurella , Pasteurella multocida , Derrame Pleural , Idoso de 80 Anos ou mais , Humanos , Masculino , Infecções por Pasteurella/diagnóstico , Pasteurella multocida/genética , Escarro
15.
Infect Dis Now ; 51(7): 590-595, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34581278

RESUMO

We evaluated the association between macrophage polarization and the development of pleural thickening in patients with tuberculous pleurisy. Patients with tuberculous pleurisy admitted to our hospital between October 2018 and March 2019 were prospectively recruited. Pleural fluid samples were obtained before treatment for detection of adenosine deaminase (ADA) and macrophage phenotype (M1: CD14+ CD86+; M2: CD14+ CD163+). Peripheral blood samples were subjected to interferon gamma release assay (IGRA). All subjects were administered standard anti-tuberculosis regimen (2HREZ/4HR); high-resolution CT was performed to determine pleural thickening (thickness>2mm) after completion of treatment. Pleural effusion in patients with thickened pleura had significantly more M1 but fewer M2 macrophages, and higher ADA level, as compared to those with normal pleura (P<0.05). No significant between-group difference was observed with respect to IGRA. In receiver operating characteristic (ROC) curve analysis, the optimal cut-off level of M1/M2 ratio for predicting pleural thickening was 1.149 (area under the curve: 0.842; sensitivity: 88.6%; specificity: 69.2%; positive predictive value: 86.3%; negative predictive value: 81.7%). M1/M2 ratio in the pleural fluid is a promising marker for predicting the development of pleural thickening in patients with tuberculous pleurisy. Macrophage-mediated immune response may play an important role in the pathogenesis of tuberculous pleurisy.


Assuntos
Derrame Pleural , Tuberculose Pleural , Adenosina Desaminase , Humanos , Macrófagos , Sensibilidade e Especificidade
17.
Int J Infect Dis ; 111: 172-178, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34384896

RESUMO

OBJECTIVES: To explore the negative predictive value (NPV) of C-reactive protein (CRP) at admission to exclude complicated disease manifestations of pneumococcal disease. METHODS: A Dutch multicentre retrospective cohort study was conducted between 01-01-2012 and 30-06-2020. Adults with positive blood cultures for Streptococcus pneumoniae, whose CRP was measured at admission and whose infection focus was known, were included. Electronic medical and microbiological records were reviewed. RESULTS: Of the 832 bacteraemic patients enrolled, 30% had complicated manifestations of pneumococcal disease; most frequent were pleural effusion (8.9%), pleural empyema (5.4%) and meningitis (7.5%). Compared to solitary pneumonia, patients with pleural effusion and empyema presented with higher CRP levels. Although low CRP levels did not exclude complicated disease in general, a CRP level < 114 mg/L at admission could reliably exclude empyema among adult pneumonia patients with an NPV of 93% and a specificity of 26%. However, in cases where pleural fluid was present, CRP levels were mostly > 114 mg/L, such that suspicion of empyema could only be ruled out in a minority of cases (10%). CONCLUSIONS: Complicated manifestations are prevalent in adult pneumococcal bacteraemia. Low blood CRP levels can reliably exclude the development of pulmonary empyema. Practical value may be largest in settings without thoracic imaging at hand.


Assuntos
Bacteriemia , Derrame Pleural , Infecções Pneumocócicas , Pneumonia Pneumocócica , Adulto , Bacteriemia/diagnóstico , Proteína C-Reativa , Humanos , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/diagnóstico , Pneumonia Pneumocócica/complicações , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/epidemiologia , Estudos Retrospectivos
18.
S D Med ; 74(8): 368-371, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34461002

RESUMO

Yellow nail syndrome (YNS) has traditionally been thought of as a triad of exudative pleural effusion, yellow nails, and lymphedema. More recently, in addition to the hallmark yellowish nail discoloration, the diagnostic criteria required an associated lymphedema and/or chronic respiratory manifestations including pleural effusions, bronchiectasis or chronic sinusitis. Etiology remains unknown and treatment is supportive and directed towards patient's specific complaints. While described alongside multiple endocrine, lymphatic and autoimmune disorders, its most ominous association is malignancy, raising YNS as a possible paraneoplastic condition. Here we present the case of an 80 years-old female with worsening restrictive airway disease and acquired yellow nails, with development of dyspnea, cough and leg edema. Recurrent exudative lymphocyte predominant pleural effusion was treated definitively with pleurodesis. Her leg edema and yellow nails were treated conservatively. We describe previous case reports and series in the literature, outline therapeutic options and discuss prognosis.


Assuntos
Bronquiectasia , Linfedema , Derrame Pleural , Sinusite , Síndrome das Unhas Amareladas , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfedema/diagnóstico , Linfedema/terapia , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/terapia , Síndrome das Unhas Amareladas/complicações , Síndrome das Unhas Amareladas/diagnóstico , Síndrome das Unhas Amareladas/terapia
19.
S D Med ; 74(9): 434-439, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34461681

RESUMO

Chylothorax is the presence of a chylous effusion in the pleural space. Diagnosing chylothorax requires a high clinical suspicion, awareness of the different appearances of a chylothorax and the performance of tests on the pleural fluid, additional to those typically required to differentiate an exudate from a transudate based on Light's criteria. Chylothorax is a more common diagnosis in the trauma and post-surgical patients, but it is still important for practitioners of other disciplines to be aware of it. In this article we provide a concise summary of chylothorax diagnosis and management.


Assuntos
Quilotórax , Derrame Pleural , Quilotórax/diagnóstico , Quilotórax/terapia , Exsudatos e Transudatos , Humanos
20.
Vet Clin Pathol ; 50(3): 394-403, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34431116

RESUMO

BACKGROUND: The classification of effusions in human medicine currently uses biochemical parameters of verified analytical accuracy, while veterinary medicine is traditionally guided by protein content (TP) and total nucleated cell count (TNCC) in the effusion, without solid scientific support. OBJECTIVE: We aimed to assess the accuracy of the current veterinary classification system to distinguish transudates from exudates and create new tools involving biochemical parameters that better classify canine cavitary effusions. METHODS: Clinical, laboratory, and imaging data from 250 canine pleural and peritoneal effusions were retrospectively and prospectively collected, organized, and statistically evaluated. Multiple logistic regression analysis was performed using biochemical and cellular parameters. RESULTS: For identifying exudates, the accuracy (87.7%, n = 204) of the best traditional classification system (TNCC > 3000 cells/µL) was similar to that of the individual biochemical cutoff values with the greatest accuracy in the abdominal cavity (eg, cholesterol, CHO-E > 40.1 mg/dL, 87.3%, n = 55). The accuracy of albumin (ALB-E > 0.8 g/dL) in the pleural cavity was nonetheless higher (100%, n = 23). The best multiple predictive models for any cavity used the percentage of neutrophils and CHO-E (n = 72), presenting an accuracy, sensitivity, and specificity for the diagnosis of exudate of 88%, 96%, and 67%, respectively. CONCLUSIONS: Biochemical classification of pleural effusions has a higher accuracy than the traditional system (based on TP and TNCC). Utility and cutoff of analytes are different for each cavity. Implementing a multiple regression model or establishing ratios or gradients with concurrent serum values adds no significant improvement in the diagnostic potential of distinguishing transudate and exudates in dogs.


Assuntos
Doenças do Cão , Derrame Pleural , Albuminas , Animais , Líquido Ascítico , Doenças do Cão/diagnóstico , Cães , Exsudatos e Transudatos , Derrame Pleural/diagnóstico , Derrame Pleural/veterinária , Estudos Retrospectivos , Sensibilidade e Especificidade
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