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Lactate determination in pleural and abdominal effusions: a quick diagnostic marker of exudate—a pilot study

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Abstract

Pleural or abdominal effusions are frequent findings in ICU and Internal Medicine patients. Diagnostic gold standard to distinguish between transudate and exudate is represented by “Light’s Criteria,” but, unfortunately, the chemical–physical examination for their calculation is not a rapid test. Pursuing an acid–base assessment of the fluid by a blood-gas analyzer, an increase of lactate beyond the normal serum range is reported in the exudative effusions. The advantages of this test are that it is a very fast bed-side test, executable directly by the physician. The aim of this study is to evaluate whether the increase in lactate in pleural and abdominal effusions might be used as a criterion for the differential diagnosis of the nature of the fluid. Sixty-nine patients with pleural or abdominal effusions and clinical indication for thoracentesis or paracentesis were enrolled. Acid–base assessment with lactate, total protein, and LDH dosage on the serum, and acid–base assessment with lactate, total protein, and LDH dosage, cytology, and bacterial culture on the fluid were performed to each patient. Fluid–blood lactate difference (ΔLacFB) and fluid–blood lactate ratio (LacFB ratio) were calculated. A statistical analysis was carried out for fluid lactate (LacF), ΔLacFB, and LacFB ratio, performing ROC curves to find the cut-off values with best sensitivity (Sn) and specificity (Sp) predicting an exudate diagnosis: LacF: cut-off value: 2.4 mmol/L; AU-ROC 0.854 95% CI 0.756–0.952; Sn 0.77; Sp 0.84. ΔLacFB: cut-off value: 0.95 mmol/L; Au-ROC 0.876 95% CI 0.785–0.966; Sn 0.80; Sp 0.92. LacFB ratio: cut-off value: 2 mmol/L; Au-ROC 0.730 95% CI 0.609–0.851; Sn 0.74; Sp 0.65. Lactate dosage by blood-gas analyzer on pleural and abdominal effusions seems to be a promising tool to predict a diagnosis of exudate.

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Authors and Affiliations

  1. Emergency Department, “A. Cardarelli” Hospital, Via Cardarelli 9, 80131, Naples, Italy

    Giovanni Porta, Antonio Pagano, Giorgio Bosso, Claudia Serra & Fiorella Paladino

  2. Emergency Department, “San Paolo” Hospital, Naples, Italy

    Fabio G. Numis & Fernando Schiraldi

  3. Internal Medicine and Hepatology Department, Second University of Naples, Naples, Italy

    Valerio Rosato, Luca Rinaldi, Maria C. Fascione & Annalisa Amelia

  4. Internal Medicine and Hepatology Unit, University of Salerno, Baronissi, Italy

    Mario Masarone

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  1. Giovanni Porta
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  2. Fabio G. Numis
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  3. Valerio Rosato
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  4. Antonio Pagano
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  5. Mario Masarone
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  6. Giorgio Bosso
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  7. Claudia Serra
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  8. Luca Rinaldi
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  9. Maria C. Fascione
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  12. Fernando Schiraldi
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Corresponding author

Correspondence to Giovanni Porta.

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The authors declare that they have no competing interests.

Ethical standards

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

Additional information

This research was performed in two Emergency Departments and in an Internal Medicine Department of Southern Italy: Emergency Department “A. Cardarelli” Hospital, Naples—Emergency Department “San Paolo” Hospital, Naples—Internal Medicine and Hepatology Department, Second University of Naples, Naples.

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Porta, G., Numis, F.G., Rosato, V. et al. Lactate determination in pleural and abdominal effusions: a quick diagnostic marker of exudate—a pilot study. Intern Emerg Med 13, 901–906 (2018). https://doi.org/10.1007/s11739-017-1757-y

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  • DOI: https://doi.org/10.1007/s11739-017-1757-y

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