Department of Specialized Medicine, Federal University of the State of Rio de Janeiro, Brazil.
Department of Clinics, School of Medicine, Pleurology Teaching and Research Laboratory from Professor Mazzini Bueno Tuberculosis Research and Assistance Center, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil.
Dis Markers. 2021 Apr 10;2021:6648535. doi: 10.1155/2021/6648535. eCollection 2021.
An initial step in the evaluation of patients with pleural effusion syndrome (PES) is to determine whether the pleural fluid is a transudate or an exudate.
To investigate total adenosine deaminase (ADA) as a biomarker to classify pleural transudates and exudates.
An assay of total ADA in pleural fluids (P-ADA) was observed using a commercial kit in a population-based cohort study.
157 pleural fluid samples were collected from untreated individuals with PES due to several causes. The cause most prevalent in transudate samples (21%, = 33/157) was congestive heart failure (79%, 26/33) and that among exudate samples (71%, = 124/157) was tuberculosis (28.0%, 44/124). There was no significant difference in the proportion of either sex between the transudate and exudate groups. The median values of P-ADA were significantly different ( < 0.0001) between both total exudates (18.4 U/L; IQR, 9.85-41.4) and exudates without pleural tuberculosis (11.0 U/L; IQR, 7.25-19.75) and transudates (6.85; IQR, 2.67-11.26). For exudates, the AUC was 0.820 (95% CI, 0.751-0.877; < 0.001), with excellent discrimination. The optimum cut-off point in the ROC curve was determined as the level that provided the maximum positive likelihood ratio (PLR; 14.64; 95% CI, 2.11-101.9) and was22.0 U/L. For transudates, the AUC was 0.8245 (95% CI, 0.7470-0.9020; < 0.0001). Internal validation of the AUC after 1000 resamples was evaluated with a tolerance minor than 2%. The clinical utility was equal to 92% (95% CI, 0.84 to 0.96, < 0.05).
P-ADA is a useful biomarker for distinguishing pleural exudates from transudates.
评估胸腔积液综合征（PES）患者的第一步是确定胸腔积液是渗出液还是漏出液。
研究总腺苷脱氨酶（ADA）作为一种生物标志物来区分胸腔渗出液和漏出液。
采用商业试剂盒检测胸腔液中的总 ADA（P-ADA），在一项基于人群的队列研究中进行观察。
共收集了 157 例未经治疗的 PES 患者的胸腔积液样本，这些患者的病因各不相同。在漏出液样本中最常见的病因是充血性心力衰竭（21%，=33/157），而在渗出液样本中最常见的病因是结核（71%，=124/157）。在渗出液组和漏出液组之间，男女比例没有显著差异。两组的 P-ADA 中位数差异有统计学意义（ < 0.0001），总渗出液（18.4 U/L；IQR，9.85-41.4）和无胸腔结核渗出液（11.0 U/L；IQR，7.25-19.75）均明显高于漏出液（6.85；IQR，2.67-11.26）。对于渗出液，ROC 曲线的 AUC 为 0.820（95%CI，0.751-0.877； < 0.001），具有良好的区分度。ROC 曲线中最佳截断点为最大正似然比（PLR；14.64；95%CI，2.11-101.9）的水平，为 22.0 U/L。对于漏出液，AUC 为 0.8245（95%CI，0.7470-0.9020； < 0.0001）。对 1000 次重采样后的 AUC 进行内部验证，其容忍度小于 2%。临床效用等于 92%（95%CI，0.84 至 0.96， < 0.05）。
P-ADA 是区分胸腔渗出液和漏出液的有用生物标志物。
