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Zhao T, Zhang J, Zhang X, Wang C. Clinical significance of pleural fluid lactate dehydrogenase/adenosine deaminase ratio in the diagnosis of tuberculous pleural effusion. BMC Pulm Med 2024; 24:241. [PMID: 38750432 PMCID: PMC11097553 DOI: 10.1186/s12890-024-03055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Pleural fluid is one of the common complications of thoracic diseases, and tuberculous pleural effusion (TPE) is the most common cause of pleural effusion in TB-endemic areas and the most common type of exudative pleural effusion in China. In clinical practice, distinguishing TPE from pleural effusion caused by other reasons remains a relatively challenging issue. The objective of present study was to explore the clinical significance of the pleural fluid lactate dehydrogenase/adenosine deaminase ratio (pfLDH/pfADA) in the diagnosis of TPE. METHODS The clinical data of 618 patients with pleural effusion were retrospectively collected, and the patients were divided into 3 groups: the TPE group (412 patients), the parapneumonic pleural effusion (PPE) group (106 patients), and the malignant pleural effusion (MPE) group (100 patients). The differences in the ratios of pleural effusion-related and serology-related indicators were compared among the three groups, and receiver operating characteristic curves were drawn to analyze the sensitivity and specificity of the parameter ratios of different indicators for the diagnosis of TPE. RESULTS The median serum ADA level was higher in the TPE group (13 U/L) than in the PPE group (10 U/L, P < 0.01) and MPE group (10 U/L, P < 0.001). The median pfADA level in the TPE group was 41 (32, 52) U/L; it was lowest in the MPE group at 9 (7, 12) U/L and highest in the PPE group at 43 (23, 145) U/L. The pfLDH level in the PPE group was 2542 (1109, 6219) U/L, which was significantly higher than that in the TPE group 449 (293, 664) U/L. In the differential diagnosis between TPE and non-TPE, the AUC of pfLDH/pfADA for diagnosing TPE was the highest at 0.946 (0.925, 0.966), with an optimal cutoff value of 23.20, sensitivity of 93.9%, specificity of 87.0%, and Youden index of 0.809. In the differential diagnosis of TPE and PPE, the AUC of pfLDH/pfADA was the highest at 0.964 (0.939, 0.989), with an optimal cutoff value of 24.32, sensitivity of 94.6%, and specificity of 94.4%; this indicated significantly better diagnostic efficacy than that of the single index of pfLDH. In the differential diagnosis between TPE and MPE, the AUC of pfLDH/pfADA was 0.926 (0.896, 0.956), with a sensitivity of 93.4% and specificity of 80.0%; this was not significantly different from the diagnostic efficacy of pfADA. CONCLUSIONS Compared with single biomarkers, pfLDH/pfADA has higher diagnostic value for TPE and can identify patients with TPE early, easily, and economically.
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Affiliation(s)
- Tingting Zhao
- Department of Respiratory and Critical Care Medicine, Shandong Public Health Clinical Center, Shandong University, Shandong, 250013, China
| | - Jianhua Zhang
- Department of Respiratory and Critical Care Medicine, Shandong Public Health Clinical Center, Shandong University, Shandong, 250013, China
| | - Xiufeng Zhang
- Department of Respiratory and Critical Care Medicine, Shandong Public Health Clinical Center, Shandong University, Shandong, 250013, China.
| | - Cheng Wang
- Department of Thoracic Surgery, Shandong Public Health Clinical Center, Shandong University, Shandong, 250013, China.
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Pleural fluid interleukins for diagnosis of tuberculous pleural effusion: A systematic review and meta-analysis. Cytokine 2022; 159:156019. [DOI: 10.1016/j.cyto.2022.156019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/05/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022]
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Roofchayee ND, Adcock IM, Marjani M, Dezfuli NK, Varahram M, Garssen J, Mortaz E. T Helper Cell Subsets in the Pleural Fluid of Tuberculous Patients Differentiate Patients With Non-Tuberculous Pleural Effusions. Front Immunol 2021; 12:780453. [PMID: 34925358 PMCID: PMC8674472 DOI: 10.3389/fimmu.2021.780453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background Tuberculous pleural effusion (TPE) is one of the most common forms of extrapulmonary tuberculosis (Tb). Patients with TPE or malignant pleural effusions (MPE) frequently have a similar lymphocytic pleural fluid profile. Since the etiology of PE in various diseases is different, identifying the cellular components may provide diagnostic clues for understanding the pathogenesis. Objective We determined the frequency of T helper (Th) subtypes in the PEs for differentiation of Tb and non-Tb patients. Methods Thirty patients with TPE, 30 patients with MPE, 14 patients with empyema (EMP), and 14 patients with parapneumonic effusion (PPE) were enrolled between December 2018 and December 2019. Five-milliliter fresh PE in tubes containing heparin as an anticoagulant was obtained from patients. The frequencies of CD4+IL-9+, CD4+IL-22+, CD+IL-17+, and regulatory T-cells CD4+CD25+ FOXP3+ (Treg) were determined by flow cytometry. Results Treg cells have a lower frequency in TPE patients [4.2 (0.362-17.24)] compared with non-TPE patients [26.3 (3.349-76.93, p < 0.0001)]. The frequency of CD4+IL-9+ cells was significantly lower in TPE patients [3.67 (0.87-47.83)] compared with non-TPE groups [13.05 (1.67-61.45), p < 0.0001]. On the contrary, there was no significant difference in the frequency of CD4+IL-17+ and CD4+IL-22+ cells between TPE and non-TPE patients (p = 0.906 and p = 0.2188). Receiver-operator curve (ROC) analysis demonstrated that CD4+CD25+FOXP3+ T cells [optimal cutoff value = 13.6 (%), sensitivity 90%, specificity 75.86%] could be considered as predictor for TPE. However, adenosine deaminase [cutoff value 27.5 (IU/l), sensitivity 90%, specificity 96.5%] levels had an even greater predictive capacity. Conclusion ADA, Treg cells, and CD4+IL-9+ cells may differentiate TPE from non-TPE patients. However, these results need validation in an independent large cohort.
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Affiliation(s)
- Neda Dalil Roofchayee
- Department of Immunology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ian M Adcock
- Respiratory Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda K Dezfuli
- Department of Immunology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Mohammad Varahram
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Esmaeil Mortaz
- Department of Immunology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Garcia-Zamalloa A, Vicente D, Arnay R, Arrospide A, Taboada J, Castilla-Rodríguez I, Aguirre U, Múgica N, Aldama L, Aguinagalde B, Jimenez M, Bikuña E, Basauri MB, Alonso M, Perez-Trallero E. Diagnostic accuracy of adenosine deaminase for pleural tuberculosis in a low prevalence setting: A machine learning approach within a 7-year prospective multi-center study. PLoS One 2021; 16:e0259203. [PMID: 34735491 PMCID: PMC8568264 DOI: 10.1371/journal.pone.0259203] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyze the performance of adenosine deaminase in pleural fluid combined with other parameters routinely measured in clinical practice and assisted by machine learning algorithms for the diagnosis of pleural tuberculosis in a low prevalence setting, and secondly, to identify effusions that are non-tuberculous and most likely malignant. PATIENTS AND METHODS We prospectively analyzed 230 consecutive patients diagnosed with lymphocytic exudative pleural effusion from March 2013 to June 2020. Diagnosis according to the composite reference standard was achieved in all cases. Pre-test probability of pleural tuberculosis was 3.8% throughout the study period. Parameters included were: levels of adenosine deaminase, pH, glucose, proteins, and lactate dehydrogenase, red and white cell counts and lymphocyte percentage in pleural fluid, as well as age. We tested six different machine learning-based classifiers to categorize the patients. Two different classifications were performed: a) tuberculous/non-tuberculous and b) tuberculous/malignant/other. RESULTS Out of a total of 230 patients with pleural effusion included in the study, 124 were diagnosed with malignant effusion and 44 with pleural tuberculosis, while 62 were given other diagnoses. In the tuberculous/non-tuberculous classification, and taking into account the validation predictions, the support vector machine yielded the best result: an AUC of 0.98, accuracy of 97%, sensitivity of 91%, and specificity of 98%, whilst in the tuberculous/malignant/other classification, this type of classifier yielded an overall accuracy of 80%. With this three-class classifier, the same sensitivity and specificity was achieved in the tuberculous/other classification, but it also allowed the correct classification of 90% of malignant cases. CONCLUSION The level of adenosine deaminase in pleural fluid together with cell count, other routine biochemical parameters and age, combined with a machine-learning approach, is suitable for the diagnosis of pleural tuberculosis in a low prevalence scenario. Secondly, non-tuberculous effusions that are suspected to be malignant may also be identified with adequate accuracy.
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Affiliation(s)
- Alberto Garcia-Zamalloa
- Internal Medicine Service, Osakidetza/Basque Health Service, Mendaro Hospital, Gipuzkoa, Spain.,Mycobacterial Infection Study Group (GEIM), From the Spanish Infectious Diseases Society, Spain
| | - Diego Vicente
- Microbiology Department, Respiratory Infection and Antimicrobial Resistance Group. Osakidetza/Basque Health Service, Biodonostia Health Research Institute, Donostia University Hospital, Gipuzkoa, Spain.,Faculty of Medicine, University of the Basque Country, UPV/EHU, Gipuzkoa, Donostia, Spain
| | - Rafael Arnay
- Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Arantzazu Arrospide
- Gipuzkoa Primary Care-Integrated Health Organisation Research Unit, Osakidetza/Basque Health Service, Debagoiena Integrated Health Organisation, Alto Deba Hospital, Arrasate-Mondragon, Spain.,Epidemiology and Public Health Area, Economic Evaluation of Chronic Diseases Research Group, Biodonostia Health Research Institute, Donostia, Spain.,Kronikgune Institute for Health Services Research, Bizkaia/Barakaldo, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Spain
| | - Jorge Taboada
- Preventive Medicine and Western Gipuzkoa Clinical Research Unit, Osakidetza/Basque Health Service, Mendaro Hospital, Gipuzkoa, Spain
| | - Iván Castilla-Rodríguez
- Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna, Santa Cruz de Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Spain
| | - Urko Aguirre
- Kronikgune Institute for Health Services Research, Bizkaia/Barakaldo, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Spain.,Osakidetza/Basque Health Service, Research Unit, Galdakao University Hospital, Bizkaia, Spain
| | - Nekane Múgica
- Pneumology Service, Osakidetza/Basque Health Service, Donostia University Hospital, Gipuzkoa. Spain
| | - Ladislao Aldama
- Pneumology Service, Osakidetza/Basque Health Service, Donostia University Hospital, Gipuzkoa. Spain
| | - Borja Aguinagalde
- Thoracic Surgery Service, Osakidetza/Basque Health Service, Donostia University Hospital, Gipuzkoa, Spain
| | - Montserrat Jimenez
- Epidemiological Surveillance Unit, Health Department, Basque Government, Gipuzkoa, Spain
| | - Edurne Bikuña
- Epidemiological Surveillance Unit, Health Department, Basque Government, Gipuzkoa, Spain
| | - Miren Begoña Basauri
- Biochemistry Laboratory, Osakidetza/Basque Health Service, Mendaro Hospital, Gipuzkoa, Spain
| | - Marta Alonso
- Microbiology Department, Respiratory Infection and Antimicrobial Resistance Group. Osakidetza/Basque Health Service, Biodonostia Health Research Institute, Donostia University Hospital, Gipuzkoa, Spain
| | - Emilio Perez-Trallero
- Microbiology Department, Respiratory Infection and Antimicrobial Resistance Group. Osakidetza/Basque Health Service, Biodonostia Health Research Institute, Donostia University Hospital, Gipuzkoa, Spain
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Potential diagnostic value of pleural fluid cytokines levels for tuberculous pleural effusion. Sci Rep 2021; 11:660. [PMID: 33436672 PMCID: PMC7803752 DOI: 10.1038/s41598-020-79685-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Patients with tuberculous pleural effusion (TPE) or malignant pleural effusions (MPE) frequently have similar pleural fluid profiles. New biomarkers for the differential diagnosis of TPE are required. We determined whether cytokine profiles in the PE of patients could aid the differential diagnosis of TPE. 30 patients with TPE, 30 patients with MPE, 14 patients with empyema (EMP) and 14 patients with parapneumonic effusion (PPE) were enrolled between Dec 2018 and 2019. The levels of interleukin (IL)-6, IL-18, IL-27, CXCL8, CCL-1 and IP-10 were determined in PE by ELISA along with measurements of adenosine deaminase (ADA). The best predictors of TPE were combined ADA.IL-27 [optimal cut-off value = 42.68 (103 U ng/l2), sensitivity 100%, specificity 98.28%], ADA [cut off value 27.5 (IU/l), sensitivity 90%, specificity 96.5%] and IL-27 [cut-off value = 2363 (pg/ml), sensitivity 96.7%, specificity 98.3%, p ≤ 0.0001]. A high level of IL-6 [cut-off value = 3260 (pg/ml), sensitivity 100%, specificity 67.2%], CXCL8 [cut-off value = 144.5 (pg/ml), sensitivity 93.3%, specificity 58.6%], CCL1 [cut-off value = 54 (pg/ml), sensitivity 100%, specificity 70.7%] and IP-10 [cut-off value = 891.9 (pg/ml), sensitivity 83.3%, specificity 48.3%] were also predictive of TPE. High ADA.IL-27, ADA and IL-27 levels differentiate between TPE and non-TPE with improved specificity and diagnostic accuracy and may be useful clinically.
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Ritter K, Rousseau J, Hölscher C. The Role of gp130 Cytokines in Tuberculosis. Cells 2020; 9:E2695. [PMID: 33334075 PMCID: PMC7765486 DOI: 10.3390/cells9122695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022] Open
Abstract
Protective immune responses to Mycobacterium tuberculosis (Mtb) infection substantially depend on a delicate balance within cytokine networks. Thus, immunosuppressive therapy by cytokine blockers, as successfully used in the management of various chronic inflammatory diseases, is often connected with an increased risk for tuberculosis (TB) reactivation. Hence, identification of alternative therapeutics which allow the treatment of inflammatory diseases without compromising anti-mycobacterial immunity remains an important issue. On the other hand, in the context of novel therapeutic approaches for the management of TB, host-directed adjunct therapies, which combine administration of antibiotics with immunomodulatory drugs, play an increasingly important role, particularly to reduce the duration of treatment. In both respects, cytokines/cytokine receptors related to the common receptor subunit gp130 may serve as promising target candidates. Within the gp130 cytokine family, interleukin (IL)-6, IL-11 and IL-27 are most explored in the context of TB. This review summarizes the differential roles of these cytokines in protection and immunopathology during Mtb infection and discusses potential therapeutic implementations with respect to the aforementioned approaches.
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Affiliation(s)
- Kristina Ritter
- Infection Immunology, Research Centre Borstel, D-23845 Borstel, Germany; (K.R.); (J.R.)
| | - Jasmin Rousseau
- Infection Immunology, Research Centre Borstel, D-23845 Borstel, Germany; (K.R.); (J.R.)
| | - Christoph Hölscher
- Infection Immunology, Research Centre Borstel, D-23845 Borstel, Germany; (K.R.); (J.R.)
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Borstel-Lübeck-Riems, D-23845 Borstel, Germany
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Li S, Ma H, Gan L, Ma X, Wu S, Li M, Tang CH, Tsai HC. Cancer antigen-125 levels correlate with pleural effusions and COPD-related complications in people living at high altitude. Medicine (Baltimore) 2018; 97:e12993. [PMID: 30431573 PMCID: PMC6257551 DOI: 10.1097/md.0000000000012993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/03/2018] [Indexed: 12/25/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the most frequently encountered progressive lung disease in clinical practice. This study sought to determine the predictive ability of the tumor biomarker cancer antigen-125 (CA-125) in the identification of COPD in a cohort of 284 patients with COPD living at high altitude (with an average elevation of over 2500 m).Patients were classified by pleural effusion volumes into 4 categories and serum CA-125 concentrations were measured in each category. The analyses revealed that CA-125 concentrations were positively and significantly correlated with pleural effusion volume. CA-125 concentrations were also positively correlated with pulmonary heart disease and acute exacerbations of COPD, and negatively correlated with pulmonary hypertension.The study evidence suggests that serum CA-125 concentrations are positively correlated with the risk of pleural effusions among patients with COPD living in high-altitude areas, and that CA-125 concentrations are also correlated with pulmonary heart disease, acute exacerbations, and pulmonary hypertension.
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Affiliation(s)
| | | | - Lijun Gan
- Department of Cardiology, Qinghai Red Cross Hospital, Xining, Qinghai
| | | | - Shangjie Wu
- Department of Respiratory, Affiliated Hospital of XiangNan University, Chenzhou, Hunan Province, China
| | | | - Chih-Hsin Tang
- Graduate Institute of Basic Medical Science
- Department of Pharmacology, School of Medicine, China Medical University
- Department of Biotechnology, College of Health Science, Asia University, Taichung, Taiwan
| | - Hsiao-Chi Tsai
- Department of Scientific Education, Qinghai Red Cross Hospital, Xining, Qinghai, China
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