Solving the Light's criteria misclassification rate of cardiac and hepatic transudates.

BACKGROUND AND OBJECTIVE: Pleural transudates are most commonly due to heart failure (HF) or hepatic hydrothorax (HH), but a number of these effusions are misclassified as exudates by standard (Light's) criteria. The aim of this study was to determine the prevalence of mislabelled transudates and to establish simple alternative parameters to correctly identify them. METHODS: We retrospectively analysed the pleural fluid and serum protein, lactate dehydrogenase and albumin concentrations from 364 cardiac effusions and 102 HH. The serum-to-pleural fluid protein and albumin gradients (serum concentration minus pleural fluid concentration), as well as the pleural fluid-to-serum albumin ratio (pleural fluid concentration divided by the serum concentration) were calculated for the mislabelled transudates. RESULTS: Light's criteria had misclassified more HF-associated effusions than HH (29% vs 18%, P = 0.002). A serum-to-pleural fluid protein gradient >3.1 g/dL correctly identified 55% and 61% of the HF and HH false exudates, respectively. The figures for an albumin gradient >1.2 g/dL were 83% and 62%. Finally, a pleural fluid-to-serum albumin ratio <0.6 had identical accuracy for labelling miscategorized cardiac and liver-related effusions (78% and 77%, respectively). CONCLUSIONS: If the clinical picture is consistent with HF but the pleural fluid meets Light's exudative criteria, the measurement of the albumin rather than the protein gradient is recommended. In the context of cirrhosis, a potentially 'false' exudate is identified better by the pleural fluid-to-serum albumin ratio.

[Hepatic hydrothorax: report of a series of 77 patients]. / Hidrotórax de causa hepática: análisis de 77 pacientes.

BACKGROUND AND OBJECTIVE: To describe the clinical characteristics, the most effective treatment and survival of cirrhotic patients with hepatic hydrothorax (HH). PATIENTS AND METHOD: Descriptive and retrospective analysis of a cohort of consecutive patients with HH undergoing a diagnostic thoracentesis. The biochemical and radiological features of the pleural effusion, its control with different therapies and the factors affecting survival were evaluated, among other parameters. RESULTS: Seventy-seven patients with HH were included, of whom 14% did not have ascites. HH was right-sided in 77% of the cases, and occupied half or more of the hemithorax in 68%. Pleural fluids were transudative in 81% of the cases. Diuretic-resistant HH (27%) could be managed with liver transplantation, transjugular intrahepatic portosystemic shunt (TIPS) or indwelling pleural catheters. However, pleurodesis failed in most patients. Median survival was 9.1 months, and it was only favorably affected by liver transplantation. CONCLUSIONS: HH has a limited survival, only influenced by liver transplantation. In diuretic-resistant cases, TIPS or pleural indwelling catheters should be considered as a management option.

Hidrotórax de causa hepática: análisis de 77 pacientes / Hepatic hydrothorax: Report of a series of 77 patients

Fundamento y objetivo: Describir las características clínicas, el tratamiento más efectivo y la supervivencia de pacientes cirróticos con hidrotórax hepático (HH). Pacientes y método: Estudio descriptivo y retrospectivo de una cohorte de pacientes consecutivos con HH sometidos a una toracocentesis diagnóstica. Entre otros parámetros, se evaluaron las características bioquímicas y radiológicas del derrame pleural, el control del mismo con los tratamientos instaurados y los factores que condicionaron la supervivencia. Resultados: Se incluyeron 77 pacientes con HH. El 14% no tenía ascitis. El HH fue derecho en el 77% de los casos y ocupó la mitad o más del hemitórax en el 68%. El 81% de los líquidos pleurales eran trasudados. El HH refractario a diuréticos (27%) se pudo controlar con trasplante hepático, derivación portosistémica percutánea intrahepática (DPPI) o catéter pleural tunelizado. En cambio, la pleurodesis fracasó en la mayoría de las ocasiones. La mediana de supervivencia fue de 9,1 meses, y solo se vio influida favorablemente por el trasplante hepático. Conclusiones: El HH tiene una supervivencia limitada, solo modificable con el trasplante hepático. En los casos refractarios al tratamiento diurético se debe considerar la DPPI o el catéter pleural tunelizado (AU)

Background and objective: To describe the clinical characteristics, the Most Effective treatment and survival of cirrhotic patients with hepatic hydrothorax (HH ). Patients and method: Descriptive and retrospective analysis of a cohort of consecutive patients with HH Undergoing a diagnostic thoracentesis. The biochemical and radiological features of the pleural effusion , its Control With Different therapies and the factors affecting, survival Were EVALUATED, Among other parameters. Results: Seventy -seven patients with HH Were included, of Whom 14% did not have ascites. HH was right -sided in 77 % of the cases, and occupied half or more of the hemithorax in 68 %. Were transudative pleural fluids in 81 % of the cases you. Diuretic -resistant HH (27 % ) Could be managed with liver transplantation, transjugular intrahepatic portosystemic shunt (TIPS ) or indwelling pleural catheters. However, in Most patients failed pleurodesis. Median survival was 9.1 months , and it was only by liver transplantation Affected favorably. Conclusions: HH has a limited survival, Influenced by liver transplantation only. In diuretic -resistant cases, indwelling pleural catheters or TIPS Should be Considered as a management option (AU)