Öz
Amaç: Bu çalışma, farklı altta yatan pulmoner hastalıkları olan hastalarda plevral sıvı gaz parametrelerini değerlendirerek tanısal etkilerini incelemeyi amaçlamaktadır.
Materyal ve Metod: Akdeniz Üniversitesi ve Harran Üniversitesi Göğüs Hastalıkları Bölümü'nde gerçek-leştirilen bu retrospektif çalışma, Ocak 2018 ile Aralık 2022 arasında görüntüleme ile doğrulanmış plev-ral efüzyonu olan 118 hastayı içermektedir. Torasentez ile toplanan plevral sıvı örneklerine gaz analizi (pO₂, pCO₂, pH, HCO₃) ve standart biyokimyasal ve sitolojik değerlendirmeler yapıldı. Gaz özellikleri, tanı kategorileri arasında karşılaştırmalı olarak analiz edildi ve anlamlılık eşiği p < 0,05 olarak belirlendi.
Bulgular: Bu çalışmada, 118 hastanın 87’sine arteriyel kan gazı analizi uygulandı; hastaların ortalama yaşı 66,4±14,2 yıl olup, %72,4’ü erkekti. Plevral sıvı pH değeri hastaların %25,3’ünde asidik, %26,4’ünde normal ve %48,3’ünde alkalen olarak saptandı. Plevral sıvıların büyük çoğunluğu (%83,9) eksüdatif ve %81,6’sı unilateraldı. En sık nedenler malignite (%29,9), pnömoni (%35,6) ve kalp yetmezliği (%16,1) olarak belirlendi. Pnömoni tanısı alan olguların %45,1’inde komplike efüzyon veya ampiyem vardı. Tran-südatif efüzyonlar daha ileri yaş, daha yüksek pH ve daha düşük LDH, pCO₂ ve protein düzeyleri ile ilişki-liydi (p<0,05). Pnömoniye bağlı efüzyonlar, diğer nedenlere kıyasla daha çok erkeklerde görülmekte, daha yüksek protein düzeylerine sahip olmakta ve daha sık eksüdatif özellik göstermekteydi. Malignite grubunda ise HCO₃ ve total protein düzeyleri anlamlı olarak daha yüksekti (p<0,05).
Sonuç: Plevral sıvı gaz analizi, özellikle enfeksiyöz ve enfeksiyöz olmayan efüzyonları ayırt etmede yararlı tanısal bilgiler sunabilir.
Anahtar Kelimeler
Etik Beyan
Çalışmanın etik kurulu Akdeniz Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından alınmıştır.
Destekleyen Kurum
Yok
Kaynakça
- 1. Aleksiev V, Markov D, Yavorov B, Bechev K, Markov G, Shterev F, et al. Enhanced diagnostic approaches for malignant pleural effusions: an extensive biochemical and statistical analysis. Folia Med (Plovdiv). 2025;67(2):e145825.
- 2. Aujayeb A. A reminder of an important clinical lesson: hypoxa-emia in a pleural effusion. Y Rep. 2022;5(1):6.
- 3. De Fonseka D, Maskell N. Interpretation of pleural fluid bioc-hemistry. Br J Hosp Med. 2016;77(9):C149-52.
- 4. Lepus CM, Vivero M. Updates in effusion cytology. Surg Pathol Clin. 2018;11(3):523-44.
- 5. Mummadi SR, Stoller JK, Lopez R, Kailasam K, Gillespie CT, Hahn PY. Epidemiology of adult pleural disease in the United States. Chest. 2021;160(4):1534-51.
- 6. Saguil A, Wyrick K, Hallgren J. Diagnostic approach to pleural effusion. Am Fam Physician. 2014;90(2):99-104.
- 7. Walker SP, Morley AJ, Stadon L, De Fonseka D, Arnold DT, Medford ARL, et al. Nonmalignant pleural effusions: a prospec-tive study of 356 consecutive unselected patients. Chest. 2017;151(5):1099-105.
- 8. Tarn AC, Lapworth R. Biochemical analysis of pleural fluid: what should we measure? Ann Clin Biochem. 2001;38(4):311-22.
- 9. Pairman L, Beckert LEL, Dagger M, Maze MJ. Evaluation of pleu-ral fluid cytology for the diagnosis of malignant pleural effusion: a retrospective cohort study. Intern Med J. 2022;52(7):1154-9.
- 10. Sobhey KE, Naglaa BA. Diagnostic significance of pleural fluid pH and pCO2. Egypt J Chest Dis Tuberc. 2015;64(4):877-85.
- 11. Venkatesh B, Boots RJ, Wallis SC. Accuracy of pleural fluid pH and PCO2 measurement in a blood gas analyser: analysis of bias and precision. Scand J Clin Lab Invest. 1999;59(8):619-26.
- 12. Heffner JE, Brown LK, Barbieri C, DeLeo JM. Pleural fluid che-mical analysis in parapneumonic effusions: a meta-analysis. Am J Respir Crit Care Med. 1995;151(6):1700-8.
- 13. Sahn SA, Huggins JT, San Jose E, Alvarez-Dobano JM, Valdes L. The art of pleural fluid analysis. Clin Pulm Med. 2013;20(2):77-96.
- 14. Simmen HP, Battaglia H, Giovanoli P, Blaser J. Analysis of pH, pO2 and pCO2 in drainage fluid allows for rapid detection of in-fectious complications during the follow-up period after abdo-minal surgery. Infection. 1994;22(6):386-9.
- 15. Glińska-Suchocka K, Sławuta P, Jankowski M, Kubiak K, Spużak J, Borusewicz P. An analysis of pH, pO2 and pCO2 in the perito-neal fluid of dogs with ascites of various etiologies. Pol J Vet Sci. 2016;19(1):141-5.
- 16. Rahman NM, Mishra EK, Davies HE, Davies RJO, Lee YCG. Clini-cally important factors influencing the diagnostic measurement of pleural fluid pH and glucose. Am J Respir Crit Care Med. 2008;178(5):483-90.
- 17. Fernandez R, Bharat A. Pleural gas analysis for the identification of alveolopleural fistulae. Curr Opin Pulm Med. 2016;22(4):362-6.
- 18. Roy B, Shak HJ, Lee YCG. Pleural fluid investigations for pleural infections. J Lab Precis Med [Internet]. 2021 [cited 2023 Jan 16];6(0). Available from: https://jlpm.amegroups.com/article/view/6014
- 19. Hocanli I, Sahin A. The importance of biochemical and hemato-logical parameters in pleural effusion etiology. New Trend Med Sci 2022; 3(1): 27-35.
- 20. Light RW, MacGregor MI, Ball WC, Luchsinger PC. Diagnostic significance of pleural fluid pH and PCO2. Chest. 1973;64(5):591-6.
- 21. Tanyeri F, Bariş İ, Artvinli M. Plevra sıvılarda gaz basınçları ve pH ölçümünün tanıdaki önemi. J Exp Clin Med. 2009;1(1):66-73.
- 22. Cabrer B, Bertomeu F, Bofill D, Grau A, Jorge S, Vivancos J, et al. Value of the measurement of gases in the diagnosis of pleu-ral effusion (author’s transl). Med Clin (Barc). 1980;74(3):92-4.
Öz
Background: This study aimed to evaluate pleural fluid gas parameters in patients with different underl-ying pulmonary diseases to assess their diagnostic implications.
Materials and Methods: This study conducted at Akdeniz University Pulmonology Department and Har-ran University Pulmonology Department. The retrospective study included 118 patients with pleural effusion confirmed via imaging between January 2018 and December 2024. Pleural fluid samples collec-ted by thoracentesis underwent gas analysis (pO₂, pCO₂, pH, HCO₃) and standard biochemical and cytolo-gical evaluations. Comparative analysis of gas characteristics was performed across diagnostic categories with a significance threshold of p < 0.05.
Results: In this study, 87 of 118 patients underwent arterial blood gas analysis, with a mean age of 66.4±14.2 years and 72.4% being male. Acidic, normal, and alkaline pleural fluid pH values were obser-ved in 25.3%, 26.4%, and 48.3% of patients, respectively. Most effusions were exudative (83.9%), and unilateral (81.6%), with malignancy (29.9%), pneumonia (35.6%), and heart failure (16.1%) being the leading causes. Among pneumonia cases, 45.1% had complicated effusions or empyema. Transudative effusions were associated with older age, higher pH, and lower LDH, pCO₂, and protein levels (p<0.05). Compared to other causes, pneumonia-related effusions were more likely to be exudative, occur in males, and have higher protein levels. Malignant effusions showed significantly higher HCO₃ and protein levels (p<0.05).
Conclusions: Pleural fluid gas analysis may offer valuable diagnostic insights, particularly in differentia-ting infectious from non-infectious effusions.
Anahtar Kelimeler
Kaynakça
- 1. Aleksiev V, Markov D, Yavorov B, Bechev K, Markov G, Shterev F, et al. Enhanced diagnostic approaches for malignant pleural effusions: an extensive biochemical and statistical analysis. Folia Med (Plovdiv). 2025;67(2):e145825.
- 2. Aujayeb A. A reminder of an important clinical lesson: hypoxa-emia in a pleural effusion. Y Rep. 2022;5(1):6.
- 3. De Fonseka D, Maskell N. Interpretation of pleural fluid bioc-hemistry. Br J Hosp Med. 2016;77(9):C149-52.
- 4. Lepus CM, Vivero M. Updates in effusion cytology. Surg Pathol Clin. 2018;11(3):523-44.
- 5. Mummadi SR, Stoller JK, Lopez R, Kailasam K, Gillespie CT, Hahn PY. Epidemiology of adult pleural disease in the United States. Chest. 2021;160(4):1534-51.
- 6. Saguil A, Wyrick K, Hallgren J. Diagnostic approach to pleural effusion. Am Fam Physician. 2014;90(2):99-104.
- 7. Walker SP, Morley AJ, Stadon L, De Fonseka D, Arnold DT, Medford ARL, et al. Nonmalignant pleural effusions: a prospec-tive study of 356 consecutive unselected patients. Chest. 2017;151(5):1099-105.
- 8. Tarn AC, Lapworth R. Biochemical analysis of pleural fluid: what should we measure? Ann Clin Biochem. 2001;38(4):311-22.
- 9. Pairman L, Beckert LEL, Dagger M, Maze MJ. Evaluation of pleu-ral fluid cytology for the diagnosis of malignant pleural effusion: a retrospective cohort study. Intern Med J. 2022;52(7):1154-9.
- 10. Sobhey KE, Naglaa BA. Diagnostic significance of pleural fluid pH and pCO2. Egypt J Chest Dis Tuberc. 2015;64(4):877-85.
- 11. Venkatesh B, Boots RJ, Wallis SC. Accuracy of pleural fluid pH and PCO2 measurement in a blood gas analyser: analysis of bias and precision. Scand J Clin Lab Invest. 1999;59(8):619-26.
- 12. Heffner JE, Brown LK, Barbieri C, DeLeo JM. Pleural fluid che-mical analysis in parapneumonic effusions: a meta-analysis. Am J Respir Crit Care Med. 1995;151(6):1700-8.
- 13. Sahn SA, Huggins JT, San Jose E, Alvarez-Dobano JM, Valdes L. The art of pleural fluid analysis. Clin Pulm Med. 2013;20(2):77-96.
- 14. Simmen HP, Battaglia H, Giovanoli P, Blaser J. Analysis of pH, pO2 and pCO2 in drainage fluid allows for rapid detection of in-fectious complications during the follow-up period after abdo-minal surgery. Infection. 1994;22(6):386-9.
- 15. Glińska-Suchocka K, Sławuta P, Jankowski M, Kubiak K, Spużak J, Borusewicz P. An analysis of pH, pO2 and pCO2 in the perito-neal fluid of dogs with ascites of various etiologies. Pol J Vet Sci. 2016;19(1):141-5.
- 16. Rahman NM, Mishra EK, Davies HE, Davies RJO, Lee YCG. Clini-cally important factors influencing the diagnostic measurement of pleural fluid pH and glucose. Am J Respir Crit Care Med. 2008;178(5):483-90.
- 17. Fernandez R, Bharat A. Pleural gas analysis for the identification of alveolopleural fistulae. Curr Opin Pulm Med. 2016;22(4):362-6.
- 18. Roy B, Shak HJ, Lee YCG. Pleural fluid investigations for pleural infections. J Lab Precis Med [Internet]. 2021 [cited 2023 Jan 16];6(0). Available from: https://jlpm.amegroups.com/article/view/6014
- 19. Hocanli I, Sahin A. The importance of biochemical and hemato-logical parameters in pleural effusion etiology. New Trend Med Sci 2022; 3(1): 27-35.
- 20. Light RW, MacGregor MI, Ball WC, Luchsinger PC. Diagnostic significance of pleural fluid pH and PCO2. Chest. 1973;64(5):591-6.
- 21. Tanyeri F, Bariş İ, Artvinli M. Plevra sıvılarda gaz basınçları ve pH ölçümünün tanıdaki önemi. J Exp Clin Med. 2009;1(1):66-73.
- 22. Cabrer B, Bertomeu F, Bofill D, Grau A, Jorge S, Vivancos J, et al. Value of the measurement of gases in the diagnosis of pleu-ral effusion (author’s transl). Med Clin (Barc). 1980;74(3):92-4.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Solunum Hastalıkları, Göğüs Hastalıkları |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 20 Haziran 2025 |
| Yayımlanma Tarihi | 27 Haziran 2025 |
| Gönderilme Tarihi | 17 Mart 2025 |
| Kabul Tarihi | 10 Haziran 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 22 Sayı: 2 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty