Ischemia modified albumin in the differential diagnosis of pleural efusions

Pleural effusions are common clinical problems in our routine practice and their differential diagnosis is challenging. They are usually the complication of a systemic pathology or of another organ?s disease. There is no data of IMA measurement in pleural effusions, which is considered more sensitive to ischemia compared to numerous ischemia indicators. It is possible that ischemia is more significant in some of the pleural diseases. We suggested that in some conditions as congestive heart failure and pulmonary thromboembolism, pleural IMA levels could be higher compared to pleural effusions due to other etiologies. Therefore, we aimed to investigate the contribution of pleural IMA levels in differential diagnosis of pleural effusions.Ninety-two subjects who were admitted or sent for consultation to Department of Pulmonary Diseases of Gaziantep University Hospital between November 2008 and September 2010 were included. Thirty-one patients had transudative pleural effusions, and 61 patients had exudative pleural effusions. Etiological distributions of pleural effusions were as follows: 32 malignant, 30 transudative (congestive heart failure and other transudates), 11 tuberculosis, 5 pulmonary thromboemboli, 11 parapneumonic effusion, 3 unknown exudates.When pleural fluid IMA values were compared among etiological groups, the difference between the groups was found to be significant (p=0.001). Mean pleural fluid IMA values were found to be the highest in transudative effusions (9113.5±10864,9 ng/mL ng/mL). There were no such differences in the blood levels of IMA. The area under the receiver operating characteristic (ROC) curve was 0,832±0.045 for the cut-off level higher than 4664 ng/mL for the differentiation of transudates from exudates (sensitivity, 75%; specificity, 80%; 95% CI, 0.739 to 0.901; p=0.0001).In conclusion, the pleural iskemi modifiye albumin levels are higher in transudates compared to exudates. No such difference were observed in blood levels of IMA suggesting that either half life of iskemi modifiye albumin in pleural space might be longer compared to that of in blood or there are reasons other than ischemia cause increase in iskemi modifiye albumin levels.