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Routine measurement of pleural fluid amylase is not indicated
P Branca1, R M Rodriguez, J T Rogers
1Department of Medicine, Vanderbilt University , Nashville, Tenn, USA.
Archives of Internal Medicine
|February 15, 2001
Summary
Routine pleural fluid amylase measurement is not clinically useful or cost-effective for diagnosing effusions. Testing is only recommended when pancreatitis or esophageal rupture is suspected.
Area of Science:
- Pulmonology
- Clinical Chemistry
Background:
- Pleural fluid amylase measurement is often recommended for evaluating pleural effusions.
- The cost-effectiveness of this diagnostic approach remains undetermined.
Purpose of the Study:
- To evaluate the clinical utility and cost-effectiveness of routine pleural fluid amylase level measurement in patients with pleural effusions.
Main Methods:
- Analyzed pleural fluid from 379 patients undergoing thoracentesis for amylase, glucose, LDH, protein, and cell counts.
- Classified effusions into categories including post-cardiac surgery, malignant, transudative, parapneumonic, and others.
Main Results:
- Pleural fluid amylase levels did not aid in determining the effusion's origin in any patient.
- Elevated amylase (>100 U/L) was found in only 1.3% of patients, with diverse underlying conditions.
Conclusions:
- Routine pleural fluid amylase testing is not clinically indicated and lacks cost-effectiveness.
- Consider pleural fluid amylase measurement only when suspecting pancreatitis or esophageal rupture.