Diagnostic Value of the Biochemical Composition of Pericardial Effusions in Patients Undergoing Pericardiocentesis

doi:10.1016/j.amjcard.2006.12.048

The American Journal of Cardiology

Volume 99, Issue 9, 1 May 2007, Pages 1294-1297

https://doi.org/10.1016/j.amjcard.2006.12.048 Get rights and content

In contrast to pleural effusion or ascites, there are few data regarding the chemical and cell-count parameters of pericardial effusions (PEs) to aid diagnosis. In the present work, all patients who underwent pericardiocentesis during a 9-year period (1995 to 2004) at a tertiary hospital and who had available fluid laboratory results were retrospectively identified. Causes of PE were diagnosed using predetermined criteria. The results of pericardial fluid biochemical and hematologic tests were compared with blood test results and analyzed to identify cut-off points that could distinguish among the various causes or among various groups of causes. Of 173 patients who underwent pericardiocentesis in the study period, 120 had available fluid laboratory results, and these patients constituted the study population. The most common causes of PE were neoplastic, idiopathic, and effusion related to acute pericarditis (accounting for 42, 22, and 17 of 120 patients, respectively). Most fluids (118 of 120) would have been classified as exudates by adopting Light’s pleural effusion criteria. Moreover, in all parameters examined, there was a considerable overlap of test results among the different pericardial disorders. Thus, no biochemical or cell-count parameter was found useful at reasonable accuracy for differentiating among the individual causes or among various groups of pericardial disorders. In conclusion, most PEs are exudates. The analysis of pericardial fluid biochemical and cell-count composition is generally not helpful for the diagnosis of most PEs.

Section snippets

Methods and Results

The charts of all patients who underwent pericardiocentesis in a 9-year period (January 1, 1995, to January 1, 2004) were retrieved using an institutional code for this procedure. All pericardiocenteses were performed in the cardiac catheterization unit at Sheba Medical Center (Ranat Gan, Israel), a tertiary referral center serving an urban population of 600,000 in central Israel and averaging 50,000 admissions annually. The charts were reviewed for the clinical characteristics of patients and

Discussion

Despite the systematic examination of multiple combinations of patient groups, of the 120 patients included in the present study, no single parameter or set of parameters, tested at multiple cut-off levels, proved useful to distinguish among particular causes of PE or among groups of causes. It should be acknowledged that some groups, for instance, bacterial or uremic PE, were too small to exclude a possibly useful distinctive biochemical profile. However, these patients are mostly diagnosed by

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Pericardial fluids, as compared with pleural or peritoneal, have greater levels of protein and LDH,36–38 suggesting that they are not simply an ultrafiltrate of plasma. Therefore, most “normal pericardial fluids” are classified as exudates when adopting Light’s criteria.37,39 It seems that the infrequent finding of a pericardial “transudate” would only help to reliably rule out tuberculosis.
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Pericardial fluid samples are usually sent to the laboratory for further analyses, unless the etiology is crystal clear such as in iatrogenic effusions. Standard tests to determine whether serous fluid is an exsudate or a transudate, including protein, glucose, cell count, LDH, are rarely informative, however, as most pericardial effusions appear to be exsudates [43,44]. Still, a low glucose level can be useful for early diagnosis of bacterial pericarditis.
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Blood and sputum cultures are also recommended. Typically, the pericardial fluid is very thick and purulent, and the pericardial-fluid analysis finds a low pericardial/serum glucose ratio (mean, 0.3) and an elevated white blood cell count with a high proportion of neutrophils (mean cell count, 2800 μg/mL; 92% neutrophils).35 Chest computed tomography scan can also be helpful to recognize the adjacent infection.
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Clinical laboratories are regularly requested to inspect uncommon body fluids obtained from patients because clinicians are uncertain as to the origin of the collected material. They may need this information for the actual diagnosis, to confirm a supposition, or for guiding treatment and invasive operations like draining and puncturing. Often there is also a need to know more precisely what is going on in the cavity that gave rise to the fluid, for instance a local infection or metastasis, or whether the cavity is connected to organs or fluid compartments nearby etcetera. The results of the laboratory investigations often have () direct consequences. As the investigation of uncommon body fluids is distinct from routine laboratory analyses it requires special attention. This paper presents an overview of the characteristics of uncommon human body fluids, constituents useful as markers for recognizing and differentiating fluids and considerations that have to be taken into account when interpreting the results of analyses. In addition a number of practical recommendations for approaching the task of identifying uncommon body fluids are given.
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MiscellaneousDiagnostic Value of the Biochemical Composition of Pericardial Effusions in Patients Undergoing Pericardiocentesis

Section snippets

Methods and Results

Discussion

Chest

Chest

Large symptomatic pericardial effusion as the presentation of unrecognized cancer—a study in 173 consecutive patients undergoing pericardiocentesis

Medicine

Miscellaneous
Diagnostic Value of the Biochemical Composition of Pericardial Effusions in Patients Undergoing Pericardiocentesis