Comparison of Light's criteria and pleural fluid cholesterol to distinguish exudative and transudative pleural fluid.
Comparison of Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value when using Lights Criteria to Differentiate Exudate and Transudate and when using Pleural Fluid Cholesterol to Differentiate Exudate and Transudate among Various Studies Marina Rohit Costa MD Rungta et al  et al  Light's Criteria Sensitivity 98% 98% Specificity 82% 82% PPV -- 90% NPV -- 82.9% Cut-off point Cut-off point >45 mg/dL >45 mg/dL Pleural fluid Sensitivity 90% 90% Cholesterol Specificity 100% 99% PPV -- 93% NPV -- 95% Anand K.
* An effusion should be classified as either an exudate or a transudate using the modified Light's criteria
Results: After using multiple parallel tests, the sensitivity, specificity, and accuracy of Light's criteria for diagnosing exudates were 98.9%, 75%, and 95% and those for transudates were 95.29%, 80%, and 93%, respectively.
The rationale of this study was also to compare the usefulness of the new criteria with classical Light's criteria.
The misclassification of transudates and exudates were less pleural fluid to serum cholinesterase ration, compared to all other parameters and Light's criteria
. But even pleural fluid to serum cholinesterase ratio misclassified one each case of transudate and exudate.
It has been conducted to study the significance of Pleural fluid LDH, Cholesterol and ADA levels in comparison to light's criteria
for rapid and accurate evaluation of pleural effusion especially the exudates.
In 21 patients, pleural effusions were clinically attributed to heart failure; however, 14 of these 21 patients were classified as exudates by Light's criteria
. The Median (25th to 75th percentiles) NT-proBNP levels of serum and pleural fluid due to congestive heart failure in these 21 patients were 4747 pg/mL (931-15754) and 4827 pg/mL (1290-12.430), while the median NT-proBNP levels of serum and pleural fluid related to non-cardiac reasons were 183 pg/mL (138-444) and 245 pg/mL (187556) respectively (p < 0.001 for both).
Hence, this study was undertaken to evaluate the diagnostic efficacy of pseudocholinesterase levels in pleural fluids and the fluid to serum ratio of pseudocholinesterase in differentiation between transudates and exudates and compare it with Light's criteria
For many years the most accepted criteria for discriminating transudative from exudative pleural effusion is Light's criteria
. (1) However Light's criteria
may differentiate certain transudative effusion as exudative effusion.