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lüll Determining the aetiology of pulmonary oedema by the oedema fluid-to-plasma protein ratio Ware LB; Fremont RD; Bastarache JA; Calfee CS; Matthay MAEur Respir J 2010[Feb]; 35 (2): 331-7We hypothesised that the oedema fluid-to-plasma protein (EF/PL) ratio, a noninvasive measure of alveolar capillary membrane permeability, can accurately determine the aetiology of acute pulmonary oedema. 390 mechanically ventilated patients with acute pulmonary oedema were enrolled. A clinical diagnosis of acute lung injury (ALI), cardiogenic pulmonary oedema or a mixed aetiology was based on expert medical record review at the end of hospitalisation. The EF/PL ratio was measured from pulmonary oedema fluid and plasma samples collected at intubation. 209 patients had a clinical diagnosis of ALI, 147 had a diagnosis of cardiogenic pulmonary oedema and 34 had a mixed aetiology. The EF/PL ratio had an area under the receiver-operating curve of 0.84 for differentiating ALI from cardiogenic pulmonary oedema. Using a predefined cut-off of 0.65, the EF/PL ratio had a sensitivity of 81% and a specificity of 81% for the diagnosis of ALI. An EF/PL ratio >/=0.65 was also associated with significantly higher mortality and fewer ventilator-free days. Noninvasive measurement of the EF/PL ratio is a safe and reliable bedside method for rapidly determining the aetiology of acute pulmonary oedema that can be used at the bedside in both developed and developing countries.|Adult[MESH]|Aged[MESH]|Blood Proteins/*analysis[MESH]|Cohort Studies[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Oxygen/metabolism[MESH]|Permeability[MESH]|Pulmonary Alveoli/metabolism[MESH]|Pulmonary Edema/blood/*diagnosis/*etiology[MESH]|ROC Curve[MESH]|Respiratory Distress Syndrome/blood/*diagnosis/*etiology[MESH] |