The pleural fluid lactate dehydrogenase/adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusions
Abstract Background Although pleural fluid lactate dehydrogenase (LDH) and adenosine deaminase (ADA) levels are often used to distinguish between tuberculous pleural effusion (TPE) and parapneumonic pleural effusion (PPE), this can be challenging as the LDH level may vary from normal to severely inc...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-12-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s12890-017-0526-z |
| _version_ | 1811306340279123968 |
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| author | Jinlin Wang Jun Liu Xiaohong Xie Panxiao Shen Jianxing He Yunxiang Zeng |
| author_facet | Jinlin Wang Jun Liu Xiaohong Xie Panxiao Shen Jianxing He Yunxiang Zeng |
| author_sort | Jinlin Wang |
| collection | DOAJ |
| description | Abstract Background Although pleural fluid lactate dehydrogenase (LDH) and adenosine deaminase (ADA) levels are often used to distinguish between tuberculous pleural effusion (TPE) and parapneumonic pleural effusion (PPE), this can be challenging as the LDH level may vary from normal to severely increased in PPE and a significantly elevated ADA is frequently measured in both conditions. In this study, we evaluated use of the pleural fluid LDH/ADA ratio as a new parameter to discriminate TPE from PPE. Methods A retrospective study was conducted in patients with pathologically-confirmed TPE (n = 72) and PPE (n = 47) to compare pleural fluid LDH and ADA levels and LDH/ADA ratios between the 2 groups. A receiver operating characteristic (ROC) curve was constructed for identifying TPE. Results The median pleural fluid LDH and ADA levels and LDH/ADA ratios in the TPE and PPE groups were: 364.5 U/L vs 4037 U/L (P < .001), 33.5 U/L vs 43.3 U/L (P = .249), and 10.88 vs 66.91 (P < .0001), respectively. An area under the ROC curve of 0.9663 was obtained using the LDH/ADA ratio as the indicator for TPE identification, and the sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were, respectively, 93.62%, 93.06%, 13.48, and 0.068 at a cut-off level of 16.20. Conclusions The pleural fluid LDH/ADA ratio, which can be determined from routine biochemical analysis, is highly predictive of TPE at a cut-off level of 16.20. Measurement of this parameter may be helpful for clinicians in distinguishing between TPE and PPE. |
| first_indexed | 2024-04-13T08:42:42Z |
| format | Article |
| id | doaj.art-d4a7e7cffe0540af9a4d0209705e81a3 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-13T08:42:42Z |
| publishDate | 2017-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-d4a7e7cffe0540af9a4d0209705e81a32022-12-22T02:53:50ZengBMCBMC Pulmonary Medicine1471-24662017-12-011711610.1186/s12890-017-0526-zThe pleural fluid lactate dehydrogenase/adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusionsJinlin Wang0Jun Liu1Xiaohong Xie2Panxiao Shen3Jianxing He4Yunxiang Zeng5Department of Respiratory DiseaseDepartment of Cardiothoracic SurgeryDepartment of Respiratory DiseaseDepartment of Respiratory DiseaseDepartment of Cardiothoracic SurgeryDepartment of Respiratory DiseaseAbstract Background Although pleural fluid lactate dehydrogenase (LDH) and adenosine deaminase (ADA) levels are often used to distinguish between tuberculous pleural effusion (TPE) and parapneumonic pleural effusion (PPE), this can be challenging as the LDH level may vary from normal to severely increased in PPE and a significantly elevated ADA is frequently measured in both conditions. In this study, we evaluated use of the pleural fluid LDH/ADA ratio as a new parameter to discriminate TPE from PPE. Methods A retrospective study was conducted in patients with pathologically-confirmed TPE (n = 72) and PPE (n = 47) to compare pleural fluid LDH and ADA levels and LDH/ADA ratios between the 2 groups. A receiver operating characteristic (ROC) curve was constructed for identifying TPE. Results The median pleural fluid LDH and ADA levels and LDH/ADA ratios in the TPE and PPE groups were: 364.5 U/L vs 4037 U/L (P < .001), 33.5 U/L vs 43.3 U/L (P = .249), and 10.88 vs 66.91 (P < .0001), respectively. An area under the ROC curve of 0.9663 was obtained using the LDH/ADA ratio as the indicator for TPE identification, and the sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were, respectively, 93.62%, 93.06%, 13.48, and 0.068 at a cut-off level of 16.20. Conclusions The pleural fluid LDH/ADA ratio, which can be determined from routine biochemical analysis, is highly predictive of TPE at a cut-off level of 16.20. Measurement of this parameter may be helpful for clinicians in distinguishing between TPE and PPE.http://link.springer.com/article/10.1186/s12890-017-0526-zPleural fluidLactate dehydrogenaseAdenosine deaminaseTuberculous pleural effusionParapneumonic pleural effusion |
| spellingShingle | Jinlin Wang Jun Liu Xiaohong Xie Panxiao Shen Jianxing He Yunxiang Zeng The pleural fluid lactate dehydrogenase/adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusions BMC Pulmonary Medicine Pleural fluid Lactate dehydrogenase Adenosine deaminase Tuberculous pleural effusion Parapneumonic pleural effusion |
| title | The pleural fluid lactate dehydrogenase/adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusions |
| title_full | The pleural fluid lactate dehydrogenase/adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusions |
| title_fullStr | The pleural fluid lactate dehydrogenase/adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusions |
| title_full_unstemmed | The pleural fluid lactate dehydrogenase/adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusions |
| title_short | The pleural fluid lactate dehydrogenase/adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusions |
| title_sort | pleural fluid lactate dehydrogenase adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusions |
| topic | Pleural fluid Lactate dehydrogenase Adenosine deaminase Tuberculous pleural effusion Parapneumonic pleural effusion |
| url | http://link.springer.com/article/10.1186/s12890-017-0526-z |
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