{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:10:04Z","timestamp":1785431404052,"version":"3.56.0"},"reference-count":18,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Recep Tayyip Erdo\u011fan University","award":["02026007008467"],"award-info":[{"award-number":["02026007008467"]}]},{"award":["02026007008467"],"award-info":[{"award-number":["02026007008467"]}],"id":[{"id":"https:\/\/ror.org\/0468j1635","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Differentiating exudative from transudative pleural effusions is essential for accurate diagnosis and management. Although Light\u2019s criteria remain the standard diagnostic method, they may incorrectly classify a substantial proportion of transudative effusions as exudates. This study aimed to evaluate the diagnostic performance of pleural fluid cholesterol and compare it with Light\u2019s criteria. Methods: This retrospective study included 751 patients with pleural effusion who underwent diagnostic evaluation between 2015 and 2024 and had a definitive etiological diagnosis. All patients underwent ultrasound-guided thoracentesis with simultaneous pleural fluid and serum biochemical analyses. Based on final etiological diagnosis, effusions were classified as transudative or exudative. Results: The mean age was 68.6 \u00b1 15.8 years. Of the pleural effusions, 516 (68.7%) were exudative and 235 (31.3%) were transudative. Malignant pleural effusion was the most common cause of exudates, whereas congestive heart failure predominated among transudates. Pleural fluid cholesterol levels were significantly higher in exudative than transudative effusions (91.1 \u00b1 30.7 vs. 28.9 \u00b1 13.5 mg\/dL, p &lt; 0.001). Receiver operating characteristic (ROC) analysis demonstrated excellent diagnostic performance for pleural fluid cholesterol (AUC = 0.976, 95% CI 0.965\u20130.987, p &lt; 0.001). A pleural cholesterol cut-off value of \u226550 mg\/dL demonstrated 92.2% sensitivity, 94.9% specificity, 97.5% positive predictive value, and 84.8% negative predictive value for identifying exudative effusions. Light\u2019s criteria showed higher sensitivity (99.2%) but lower specificity (84.4%). Light\u2019s criteria misclassified 15.6% of transudative effusions as exudates, whereas pleural cholesterol misclassified only 5.1%. Conclusions: Pleural fluid cholesterol measurement demonstrated high diagnostic accuracy in differentiating exudative and transudative pleural effusions and substantially reduced false exudate classification compared with Light\u2019s criteria. Routine assessment of pleural cholesterol may improve the diagnostic evaluation of pleural effusions.<\/jats:p>","DOI":"10.3390\/life16071195","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:47:32Z","timestamp":1784508452000},"page":"1195","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effectiveness of Pleural Cholesterol Levels in Differentiating Transudate from Exudate and Comparison with Light\u2019s Criteria"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5396-5402","authenticated-orcid":false,"given":"Aziz","family":"Gumus","sequence":"first","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Recep Tayyip Erdogan University, 53100 Rize, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9081-9559","authenticated-orcid":false,"given":"Elvan","family":"Senturk Topaloglu","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Recep Tayyip Erdogan University, 53100 Rize, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4672-6179","authenticated-orcid":false,"given":"Neslihan","family":"Ozcelik","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Recep Tayyip Erdogan University, 53100 Rize, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdurrahman","family":"Kotan","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Erzurum Regional Training and Research Hospital, 25050 Erzurum, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0792-8894","authenticated-orcid":false,"given":"Hasan Veysel","family":"Keskin","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon University, 61040 Trabzon, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5652-6018","authenticated-orcid":false,"given":"Omer","family":"Topaloglu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Faculty of Medicine, Recep Tayyip Erdogan University, 53100 Rize, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9768-1425","authenticated-orcid":false,"given":"Songul","family":"Ozyurt","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine, Recep Tayyip Erdogan University, 53100 Rize, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.arbres.2013.11.007","article-title":"Etiology of pleural effusions: Analysis of more than 3000 consecutive thoracenteses","volume":"50","author":"Porcel","year":"2014","journal-title":"Arch. 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