Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Tongdao North Street 1, Hohhot, 010050, China.
Department of Parasitology, The Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, 010050, China.
BMC Pulm Med. 2022 Nov 19;22(1):428. doi: 10.1186/s12890-022-02247-w.
This study aimed to evaluate the diagnostic accuracy of pleural fluid (PF) lactate dehydrogenase (LDH) to adenosine deaminase (ADA) (LDH/ADA) ratio for tuberculous pleural effusion (TPE). Especially to explore whether the LDH/ADA ratio provides added diagnostic value to ADA.
The diagnostic accuracy of PF LDH/ADA ratio and ADA for TPE was evaluated in two cohorts, named the BUFF (Biomarkers for patients with Undiagnosed pleural eFFusion) cohort (62 with TPE and 194 with non-TPE) and the SIMPLE (a Study Investigating Markers in PLeural Effusion) cohort (33 with TPE and 177 with non-TPE). Receiver operating characteristic (ROC) curve and decision curve were used to measure the diagnostic accuracy of the PF LDH/ADA ratio. The added diagnostic value of the LDH/ADA ratio to ADA was evaluated with net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
The area under the ROC curves (AUCs) of PF ADA and LDH/ADA ratio in the BUFF cohort were 0.76 and 0.74, respectively. In the SIMPLE cohort, the AUCs of PF ADA and LDH/ADA ratio were 0.80 and 0.85, respectively. The decision curves of PF LDH/ADA and ADA were close in both the BUFF and SIMPLE cohorts. The NRI and IDI analyses did not reveal any added diagnostic value of LDH/ADA to ADA.
PF LDH/ADA ratio has moderate diagnostic accuracy for TPE. It does not provide added diagnostic value beyond ADA. The current evidence does not support LDH/ADA ratio for diagnosing TPE.
本研究旨在评估胸腔积液（PF）乳酸脱氢酶（LDH）与腺苷脱氨酶（ADA）（LDH/ADA）比值对结核性胸腔积液（TPE）的诊断准确性。特别是探讨 LDH/ADA 比值是否为 ADA 提供了额外的诊断价值。
我们在两个队列中评估了 PF LDH/ADA 比值和 ADA 对 TPE 的诊断准确性，这两个队列分别命名为 BUFF（Biomarkers for patients with Undiagnosed pleural eFFusion，未确诊胸腔积液患者的生物标志物）队列（62 例 TPE 和 194 例非 TPE）和 SIMPLE（a Study Investigating Markers in PLeural Effusion，胸腔积液标志物研究）队列（33 例 TPE 和 177 例非 TPE）。我们使用受试者工作特征（ROC）曲线和决策曲线来衡量 PF LDH/ADA 比值的诊断准确性。我们使用净重新分类改善（NRI）和综合判别改善（IDI）评估 LDH/ADA 比值对 ADA 的附加诊断价值。
在 BUFF 队列中，PF ADA 和 LDH/ADA 比值的 ROC 曲线下面积（AUCs）分别为 0.76 和 0.74。在 SIMPLE 队列中，PF ADA 和 LDH/ADA 比值的 AUC 分别为 0.80 和 0.85。在两个队列中，PF LDH/ADA 和 ADA 的决策曲线均非常接近。NRI 和 IDI 分析并未显示 LDH/ADA 对 ADA 有任何附加诊断价值。
PF LDH/ADA 比值对 TPE 具有中等的诊断准确性。它并未为 ADA 提供额外的诊断价值。目前的证据不支持使用 LDH/ADA 比值来诊断 TPE。
