Department of Clinical Biochemistry, Virgen del Rocío University Hospital, Manuel Siurot Avenue, 41013, Seville, Spain.
Department of Clinical Biochemistry, Puerto Real University Hospital, 1St Floor. Romería Street 7, 11510, Cádiz, Spain.
Clin Exp Med. 2023 Dec;23(8):5201-5213. doi: 10.1007/s10238-023-01194-y. Epub 2023 Sep 25.
Pleural effusion (PE) is a common medical concern, often requiring thoracentesis for a definitive diagnosis. An elevated pleural fluid adenosine deaminase (ADA) may indicate tuberculosis, but this is not always the case. This study aimed to evaluate the accuracy of biomarkers determined in pleural fluid and propose a new diagnostic strategy for PE in patients with high levels of ADA in pleural fluid. This retrospective analysis studied patients with PE who received thoracentesis for the first time with an ADA level of > 33 U/L in the pleural fluid analysis at two tertiary hospitals from March 2019 to March 2023. Demographic and clinical data, as well as pleural fluid biomarkers and their ratios, were studied and compared between different PE groups, and a decision tree was developed. During the study period, 259 patients were enrolled, with four different types of PE: parapneumonic (PPE) 155, tuberculosis (TPE) 41, malignant (MPE) 50, and miscellaneous 13. Biomarkers and their ratios performed well in the differential diagnosis of PE, with the LDH/ADA ratio distinguishing between PPE and non-PPE with sensitivity and specificity of 98.06% and 98.08%, respectively. The combination of LDH/ADA ratio, ADA, and mononuclear cell percentage was identified as important factors for creating a decision tree with an overall accuracy of 89.96%. The pleural fluid LDH/ADA ratio was a useful diagnostic for distinguishing PPE from non-PPE, and a decision tree with an accuracy of 89.96% was created to differentiate the four forms of PE in clinical situations.
胸腔积液（PE）是一种常见的医学问题，通常需要进行胸腔穿刺以明确诊断。胸腔液中升高的腺苷脱氨酶（ADA）可能提示结核，但并非总是如此。本研究旨在评估胸腔液中生物标志物的准确性，并为胸腔液 ADA 水平升高的患者提出一种新的胸腔积液诊断策略。本回顾性分析研究了 2019 年 3 月至 2023 年 3 月在两家三级医院首次接受胸腔穿刺且胸腔液 ADA 水平>33U/L 的 PE 患者。研究了不同 PE 组之间的人口统计学和临床数据以及胸腔液生物标志物及其比值，并建立了决策树。研究期间共纳入 259 例患者，PE 分为四类：肺炎旁性胸腔积液（PPE）155 例、结核性胸腔积液（TPE）41 例、恶性胸腔积液（MPE）50 例和其他类型胸腔积液 13 例。生物标志物及其比值在 PE 的鉴别诊断中表现良好，LDH/ADA 比值可区分 PPE 和非 PPE，其敏感性和特异性分别为 98.06%和 98.08%。LDH/ADA 比值、ADA 和单个核细胞百分比的组合被确定为创建具有 89.96%总体准确性的决策树的重要因素。胸腔液 LDH/ADA 比值可用于区分 PPE 和非 PPE，可创建具有 89.96%准确性的决策树以在临床情况下区分四种类型的胸腔积液。
