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Routine Measurement of Pleural Fluid Amylase Is Not Indicated
Paul Branca, MD;
R. Michael Rodriguez, MD;
Jeffrey T. Rogers, RRT;
Dereje S. Ayo, MD;
J. Phillip Moyers, MD;
Richard W. Light, MD
Arch Intern Med. 2001;161:228-232.
Background The routine measurement of pleural fluid amylase is frequently recommended,
but the cost-effectiveness of this procedure is unknown.
Methods To assess the utility of routine measurement of pleural fluid amylase
in evaluating pleural effusions, we measured amylase, glucose, lactate dehydrogenase,
and protein levels and blood cell counts in 379 patients undergoing thoracentesis
during a 22-month period from 1997 to 1999. Of these, 199 had effusions after
cardiac surgery; 61, malignant; 48, transudative; 28, parapneumonic; 2, chylous;
2, rheumatoid; 1, tuberculous; and 1, from chronic pleuritis. There were 37
exudates of unknown origin.
Results Measurement of pleural fluid amylase levels did not assist in determining
the origin of the effusion in any of the patients. Amylase levels greater
than 100 U/L (normal serum level in our laboratory is 30-110 U/L) were found
in 5 (1.3%) of 379 patients: 1 patient with congestive heart failure (amylase,
173 U/L), 2 with post–cardiac surgery effusions (144 U/L and 130 U/L),
1 with pneumonia (109 U/L), and 1 with lung cancer (105 U/L).
Conclusions The routine measurement of pleural fluid amylase levels is neither clinically
indicated nor cost-effective. We suggest that pleural fluid serum amylase
levels be measured only if there is a pretest suspicion of acute pancreatitis,
chronic pancreatic disease, or esophageal rupture.
From the Division of Allergy, Pulmonary and Critical Care Medicine,
Department of Medicine, Vanderbilt University (Drs Branca and Light), and
Pulmonary Disease Program, Department of Medicine (Drs Rodriguez, Ayo, and
Light and Mr Rogers), and Department of Radiology (Dr Moyers), St Thomas Hospital,
Nashville, Tenn.
Corresponding author: Richard W. Light, MD, Director of Pulmonary
Disease Program, St Thomas Hospital, PO Box 380, 4220 Harding Rd, Nashville,
TN 37202 (e-mail: rlight98{at}yahoo.com).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Pleural Effusion
Light
NEJM 2002;346:1971-1977.
FULL TEXT
Amylase Levels in Pleural Effusions : A Consecutive Unselected Series of 841 Patients
Villena et al.
Chest 2002;121:470-474.
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