Does this patient have an exudative pleural effusion? The Rational Clinical Examination systematic review.

Wilcox ME, Chong CA, Stanbrook MB, Tricco AC, Wong C, Straus SE.

JAMA. 2014 Jun 18;311(23):2422-31. doi: 10.1001/jama.2014.5552.

“The diagnosis of an exudate was most accurate if cholesterol in the pleural fluid was greater than 55 mg/dL (LR range, 7.1-250), lactate dehydrogenase (LDH) was greater than 200 U/L (LR, 18; 95% CI, 6.8-46), or the ratio of pleural fluid cholesterol to serum cholesterol was greater than 0.3 (LR, 14; 95% CI, 5.5-38). A diagnosis of exudate was less likely when all Light’s criteria (a ratio of pleural fluid protein to serum protein >0.5, a ratio of pleural fluid LDH to serum LDH >0.6, or pleural fluid LDH >two-thirds the upper limit of normal for serum LDH) were absent (LR, 0.04; 95% CI, 0.02-0.11).”