Citation Information :
Khalaf AR, Sedky A, Gadallah D. The Role of Pleural Lactic Acid in the Diagnosis and Differentiation of Various Causes of Exudative Pleural Effusion. Indian J Respir Care 2023; 12 (3):214-221.
Background: Pleural effusion (PE) represents a prevalent issue clinically for different diseases, such as tuberculosis (TB), pneumonia, malignancy, and heart failure (HF). So, we need specific investigations, such as measuring the level of lactic acid, for the rapid diagnosis of exudative PE causes.
Objective: To assess pleural fluid (PF) lactic acid level in exudative PEs and to detect its role as a diagnostic test with the determination of a cutoff level of PF lactic acid to distinguish between the different causes of exudative PEs, such as tuberculous, parapneumonic, and malignant.
Methods: Initial diagnostic thoracentesis was performed in all cases. The PF lactic acid level was assessed by a calibrated blood gas analyzer.
Results: We studied 80 patients. A total of 32 patients had parapneumonic pleural effusion (PPE) (15 simple and 17 complicated), 19 had tuberculous pleural effusion (TPE), and 29 had malignant pleural effusion (MPE). PF lactic acid median level was significantly more regarding the complicated PPE (CPPE) [mean 7.19 mmol/L with range (2.7:11.6)] in comparison to other groups. The area under the curve (AUC) scored 0.912 [p < 0.0001, 95% confidence interval (CI) (0.757:0.983)]. PF lactic acid cutoff level of >3.4 mmol/L was significant in predicting CPPE with high specificity and positive predictive value scored, with low sensitivity and negative predictive value (100, 100, 82.4, and 83.3%, respectively). Also, PF lactic acid could be used to discriminate between TPE and MPE. The AUC scored 0.735 [p < 0.001, 95% CI (0.588:0.852)], and the PF lactic acid optimal cutoff level was ≤2.8 mmol/L resulting in 79.3% sensitivity, 68.4% specificity, 68.4% negative predictive value, and as well as 79.3% positive predictive value regarding the prediction of MPE.
Conclusion: Pleural fluid (PF) lactic acid level measurement has a high accuracy for the diagnosis and discrimination between the different causes of exudative PE.
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