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Zhao W, Niu Y, Wen JX, Cao XS, Han YL, Wen XH, Wang MY, Hai L, Gao WH, Yan L, Zheng WQ, Hu ZD. Diagnostic accuracy of pleural fluid complement C1q for tuberculous pleural effusion in elderly patients. Cytokine 2024; 184:156778. [PMID: 39395311 DOI: 10.1016/j.cyto.2024.156778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 09/25/2024] [Accepted: 10/04/2024] [Indexed: 10/14/2024]
Abstract
BACKGROUND Previous studies indicated that pleural fluid complement C1q was helpful for diagnosing tuberculous pleural effusion (TPE), but the participants in these studies were young. The diagnostic accuracy of C1q for TPE in elderly patients remains unknown. This study aimed to investigate the diagnostic accuracy of C1q for TPE in elderly patients. METHODS We prospectively recruited patients with undiagnosed pleural effusion who visited the Affiliated Hospital of Inner Mongolia Medical University between September 2018 and July 2021. Their C1q in pleural fluid was detected, and the diagnostic accuracy of C1q was assessed by the receiver operating characteristic (ROC) curve analysis. RESULTS The median ages of patients with TPE and non-TPE were 75 and 71 years, respectively. TPE patients had significantly higher C1q than non-TPE. The area under the ROC curve (AUC) of C1q was 0.67 (95 %CI: 0.51-0.82). At the threshold of 100 mg/L, C1q had a sensitivity of 0.44 (95 %CI: 0.19-0.69) and specificity of 0.79 (95 %CI: 0.71-0.86). CONCLUSION C1q in pleural fluid has low diagnostic accuracy for TPE in elderly patients.
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Affiliation(s)
- Wen Zhao
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China; Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
| | - Yan Niu
- Department of Medical Experimental Center, Basic Medical College, Inner Mongolia Medical University, Hohhot, China
| | - Jian-Xun Wen
- Department of Medical Experimental Center, Basic Medical College, Inner Mongolia Medical University, Hohhot, China
| | - Xi-Shan Cao
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China; Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
| | - Yu-Ling Han
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China; Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
| | - Xu-Hui Wen
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China; Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
| | - Mei-Ying Wang
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China; Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
| | - Ling Hai
- Department of Pathology, Basic Medical College, Inner Mongolia Medical University, Hohhot, China; Department of Pathology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Wen-Hui Gao
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Li Yan
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China; Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Wen-Qi Zheng
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China; Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China; Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China.
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Yang DN, Yan C, Yan L, Niu Y, Wen JX, Hai L, Gao WH, Wang YJ, Wang YF, Zhou Q, Zheng WQ, Hu ZD. Apolipoprotein E in patients with undiagnosed pleural effusion: a prospective diagnostic test accuracy study. Expert Rev Respir Med 2024; 18:735-741. [PMID: 39136379 DOI: 10.1080/17476348.2024.2391943] [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: 01/01/2024] [Accepted: 08/09/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION Pleural effusion is common in clinical practice, and its differential diagnosis remains challenging for clinicians. This study investigates the diagnostic value of apolipoprotein E (apoE) in patients with undetermined pleural effusion. METHODS This prospective, double-blind study enrolled 152 patients with undiagnosed pleural effusion. Their pleural fluid apoE levels were measured, and a receiver operating characteristics (ROC) curve was used to evaluate the diagnostic accuracy of apoE. Decision curve analysis (DCA) was used to assess apoE's net benefit. Subgroup analyses were performed to investigate the effect of age on the diagnostic accuracy of apoE. RESULTS Among the included participants, 23 had heart failure (HF). HF patients had the lowest apoE level among pleural effusion patients. The area under the curve (AUC) of apoE for HF was 0.79 (95% CI: 0.69-0.89). At the threshold of 40 mg/L, the sensitivity and specificity of apoE were 0.96 (95% CI: 0.87-1.00) and 0.33 (95% CI: 0.25-0.42), respectively. The decision curve for apoE was above reference lines. The AUC of apoE decreased in older patients. CONCLUSION Pleural fluid apoE has moderate diagnostic value for HF and has net benefits in patients with undiagnosed pleural effusion. The diagnostic accuracy of apoE decreases with age.
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Affiliation(s)
- Dan-Ni Yang
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
| | - Cheng Yan
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
| | - Li Yan
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yan Niu
- Medical Experiment Center, the College of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Jian-Xun Wen
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
- Medical Experiment Center, the College of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Ling Hai
- Department of Pathology, the College of Basic Medical, Inner Mongolia Medical University, Hohhot, China
- Department of Pathology, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Wen-Hui Gao
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
| | - Ying-Jun Wang
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
| | - Ya-Fei Wang
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
| | - Qianghua Zhou
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Wen-Qi Zheng
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China
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Yan Z, Wen JX, Niu Y, Jiang TW, Huang JH, Chen H, Chen Q, Wang YF, Yan L, Hu ZD, Zheng WQ. Diagnostic accuracy and cellular origin of pleural fluid CXCR3 ligands for tuberculous pleural effusion. Cytokine 2024; 179:156618. [PMID: 38663252 DOI: 10.1016/j.cyto.2024.156618] [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: 02/18/2024] [Revised: 04/06/2024] [Accepted: 04/12/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Pleural biomarkers represent potential diagnostic tools for tuberculous pleural effusion (TPE) due to their advantages of low cost, short turnaround time, and less invasiveness. This study evaluated the diagnostic accuracy of two CXCR3 ligands, C-X-C motif chemokine ligand 9 (CXCL9) and CXCL11, for TPE. In addition, we investigated the cellular origins and biological roles of CXCL9 and CXCL11 in the development of TPE. METHODS This double-blind study prospectively enrolled patients with undiagnosed pleural effusion from two centers (Hohhot and Changshu) in China. Pleural fluid on admission was obtained and levels of CXCL9 and CXCL11 were measured by an enzyme-linked immunosorbent assay (ELISA). The receiver operating characteristic (ROC) curve and the decision curve analysis (DCA) were used to evaluate their diagnostic accuracy and net benefit, respectively. THP-1 cell-derived macrophages were treated with Bacillus Calmette-Guérin (BCG), and quantitative real-time PCR (qRT-PCR) and ELISA were used to determine the mRNA and protein levels of CXCL9 and CXCL11. The chemoattractant activities of CXCL9 and CXCL11 for T helper (Th) cells were analyzed by a transwell assay. RESULTS One hundred and fifty-three (20 TPEs and 133 non-TPEs) patients were enrolled in the Hohhot Center, and 58 (13 TPEs and 45 non-TPEs) were enrolled in the Changshu Center. In both centers, we observed increased CXCL9 and CXCL11 in TPE patients. The areas under the ROC curves (AUCs) of pleural CXCL9 and CXCL11 in the Hohhot Center were 0.70 (95 % CI: 0.55-0.85) and 0.68 (95 % CI: 0.52-0.84), respectively. In the Changshu Center, the AUCs of CXCL9 and CXCL11 were 0.96 (95 % CI: 0.92-1.00) and 0.97 (95 % CI: 0.94-1.00), respectively. The AUCs of CXCL9 and CXCL11 decreased with the advancement of age. The decision curves of CXCL9 and CXCL11 showed net benefits in both centers. CXCL9 and CXCL11 were upregulated in BCG-treated macrophages. Pleural fluid from TPE and conditioned medium from BCG-treated macrophages were chemotactic for Th cells. Anti-CXCL9 or CXCL11 neutralizing antibodies could partly block the chemotactic activity. CONCLUSIONS Pleural CXCL9 and CXCL11 are potential diagnostic markers for TPE, but their diagnostic accuracy is compromised in elderly patients. CXCL9 and CXCL11 can promote the migration of peripheral Th cells, thus representing a therapeutic target for the treatment of TPE.
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Affiliation(s)
- Zhi Yan
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China; School of Medical Laboratory & Department of Cell Biology, Tianjin Medical University, Tianjin 300203, China
| | - Jian-Xun Wen
- Department of Medical Experiment Center, the Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot 010050, China
| | - Yan Niu
- Department of Medical Experiment Center, the Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot 010050, China
| | - Ting-Wang Jiang
- Department of Key Laboratory, the Affiliated Changshu Hospital of Nantong University, Changshu 215500, China
| | - Jin-Hong Huang
- Department of Pulmonary and Critical Care Medicine, the Affiliated Changshu Hospital of Nantong University, Changshu 215500, China
| | - Hong Chen
- Department of Pulmonary and Critical Care Medicine, the Affiliated Changshu Hospital of Nantong University, Changshu 215500, China
| | - Qi Chen
- The Third Clinical Medical College of Ningxia Medical University, Yinchuan 750004, China
| | - Ya-Fei Wang
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China; Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot 010050, China
| | - Li Yan
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot 010050, China; Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China; Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot 010050, China
| | - Wen-Qi Zheng
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China; Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot 010050, China.
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Abdulelah M, Abu Hishmeh M. Infective Pleural Effusions-A Comprehensive Narrative Review Article. Clin Pract 2024; 14:870-881. [PMID: 38804400 PMCID: PMC11130797 DOI: 10.3390/clinpract14030068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
Infective pleural effusions are mainly represented by parapneumonic effusions and empyema. These conditions are a spectrum of pleural diseases that are commonly encountered and carry significant mortality and morbidity rates reaching upwards of 50%. The causative etiology is usually an underlying bacterial pneumonia with the subsequent seeding of the infectious culprit and inflammatory agents to the pleural space leading to an inflammatory response and fibrin deposition. Radiographical evaluation through a CT scan or ultrasound yields high specificity and sensitivity, with features such as septations or pleural thickening indicating worse outcomes. Although microbiological yields from pleural studies are around 56% only, fluid analysis assists in both diagnosis and prognosis by evaluating pH, glucose, and other biomarkers such as lactate dehydrogenase. Management centers around antibiotic therapy for 2-6 weeks and the drainage of the infected pleural space when the effusion is complicated through tube thoracostomies or surgical intervention. Intrapleural enzymatic therapy, used to increase drainage, significantly decreases treatment failure rates, length of hospital stay, and surgical referrals but carries a risk of pleural hemorrhage. This comprehensive review article aims to define and delineate the progression of parapneumonic effusions and empyema as well as discuss pathophysiology, diagnostic, and treatment modalities with aims of broadening the generalist's understanding of such complex disease by reviewing the most recent and relevant high-quality evidence.
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Affiliation(s)
- Mohammad Abdulelah
- Department of Internal Medicine, University of Massachusetts Chan Medical School—Baystate Campus, Springfield, MA 01199, USA
| | - Mohammad Abu Hishmeh
- Department of Internal Medicine, University of Massachusetts Chan Medical School—Baystate Campus, Springfield, MA 01199, USA
- Department of Pulmonary and Critical Care Medicine, University of Massachusetts Chan Medical School—Baystate Campus, Springfield, MA 01199, USA
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Zhao W, Jiang TW, Zheng WQ, Hu ZD. Diagnostic accuracy of adenosine deaminase for tuberculous pleural effusion: age does matter. Clin Chem Lab Med 2024; 62:e116-e118. [PMID: 37929950 DOI: 10.1515/cclm-2023-0916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Wen Zhao
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, P.R. China
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, P.R. China
| | - Ting-Wang Jiang
- Department of Key Laboratory, The Affiliated Changshu Hospital of Nantong University Changshu, P.R. China
| | - Wen-Qi Zheng
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, P.R. China
- Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, P.R. China
| | - Zhi-De Hu
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, P.R. China
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Anguamea-Maldonado J, Sanchez-Zazueta E, Vidal-Morales R. Pleural tuberculosis and endocarditis as complications of multifactorial origin in granulomatosis with polyangiitis: Clinical case report. REUMATOLOGIA CLINICA 2024; 20:104-107. [PMID: 38290955 DOI: 10.1016/j.reumae.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/08/2023] [Indexed: 02/01/2024]
Abstract
We present the case of a 36-year-old woman with a history of granulomatosis with polyangiitis; chronic kidney disease; systemic arterial hypertension. Debut with dyspnea, weakness, and hemoptysis, she was suspected in atypical pneumonia, discarded, persisting with tachypnea, tachycardia, chest pain. The protocol for pulmonary tuberculosis was started with negative sputum samples, positive blood culture for S. haemolyticus, chest tomography with left pneumothorax and ipsilateral pleural effusion, exudate-type pleural fluid was obtained, acid-fast staining, negative PCR for M. tuberculosis; A follow-up echocardiogram was performed due to a new murmur, reporting valvular vegetation, concluding a diagnosis of pleural tuberculosis and endocarditis as complications of multifactorial origin associated with immunosuppression in granulomatosis with polyangiitis.
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Affiliation(s)
- Jesús Anguamea-Maldonado
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 1 Ciudad Obregón, Sonora, Departamento de Medicina Interna, Sonora, Mexico.
| | - Eduardo Sanchez-Zazueta
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 1 Ciudad Obregón, Sonora, Departamento de Medicina Interna, Sonora, Mexico.
| | - Rene Vidal-Morales
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 1 Ciudad Obregón, Sonora, Departamento de Medicina Interna, Sonora, Mexico
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Shimoda M, Tanaka Y, Morimoto K, Yoshiyama T, Yoshimori K, Ohta K. Diagnostic flowchart for tuberculous pleurisy, pleural infection, and malignant pleural effusion. Respir Investig 2024; 62:157-163. [PMID: 38141528 DOI: 10.1016/j.resinv.2023.11.005] [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: 04/28/2023] [Revised: 10/17/2023] [Accepted: 11/22/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Several markers for the diagnosis of pleural effusion have been reported; however, a comprehensive evaluation using those markers has not been performed. Therefore, this study aimed to develop a diagnostic flowchart for tuberculous pleurisy, pleural infection, malignant pleural effusion, and other diseases by using these markers. METHODS We retrospectively collected data from 174 patients with tuberculous pleurisy, 215 patients with pleural infection other than tuberculous pleurisy, 360 patients with malignant pleural effusion, and 209 patients with other diseases at Fukujuji Hospital from January 2012 to October 2022. The diagnostic flowchart for four diseases was developed by using several previously reported markers. RESULTS The flowchart was developed by including seven markers: pleural ADA ≥40 IU/L, pleural fluid LDH <825 IU/L, pleural fluid ADA/TP < 14, neutrophil predominance or cell degeneration, peripheral blood WBC ≥9200/μL or serum CRP ≥12 mg/dL, pleural amylase ≥75 U/L, and the presence of pneumothorax according to the algorithm of a decision tree. The accuracy ratio of the flowchart was 71.7 % for the diagnosis of the four diseases, with 79.3 % sensitivity and 75.4 % positive predictive value (PPV) for tuberculosis pleurisy, 75.8 % sensitivity and 83.2 % PPV for pleural infection, 88.6 % sensitivity and 68.8 % PPV for malignant pleural effusion, and 33.0 % sensitivity and 60.0 % PPV for other diseases in the flowchart. The misdiagnosis ratios were 4.6 % for tuberculosis pleurisy, 6.8 % for pleural infection, and 8.3 % for malignant pleural effusion. CONCLUSION This study developed a useful diagnostic flowchart for tuberculous pleurisy, pleural infection, malignant pleural effusion, and other diseases.
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Affiliation(s)
- Masafumi Shimoda
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan.
| | - Yoshiaki Tanaka
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Takashi Yoshiyama
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Kozo Yoshimori
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
| | - Ken Ohta
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), Kiyose City, Tokyo, Japan
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Wen XH, Wen JX, Mu L, Cao XS, Yan L, Huang JH, Chen H, Jiang TW, Hu ZD, Niu Y, Zheng WQ. Pleural fluid soluble Fas ligand and tuberculous pleural effusion: a prospective diagnostic test accuracy study. J Thorac Dis 2023; 15:6493-6501. [PMID: 38249869 PMCID: PMC10797355 DOI: 10.21037/jtd-23-1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/25/2023] [Indexed: 01/23/2024]
Abstract
Background The diagnosis of tuberculous pleural effusion (TPE) is challenging for pulmonologists. Adenosine deaminase (ADA), interferon-gamma (IFN-γ), and interleukin-27 (IL-27) have some limitations for diagnosing TPE. Soluble Fas ligand (sFasL) had a high diagnostic value for TPE. However, it remains unknown: (I) whether sFasL has an additional diagnostic value to the traditional markers (e.g., ADA); (II) whether sFasL provides a net benefit in patients with undiagnosed pleural effusion; (III) factors affecting the diagnostic accuracy of sFasL for TPE. This study aimed to evaluate the additional diagnostic value and benefit of pleural fluid sFasL for TPE. Methods We prospectively enrolled 211 patients with undiagnosed pleural effusion. The concentration of sFasL in pleural fluid was measured by an enzyme-linked immunosorbent assay (ELISA). The diagnostic accuracy and net benefit of sFasL and ADA for TPE were analyzed by a receiver operating characteristic (ROC) curve, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discriminant improvement (IDI). Results The area under the ROC curves (AUCs) of sFasL and ADA were 0.74 (95% CI: 0.65-0.83) and 0.80 (95% CI: 0.71-0.90), respectively. The decision curve of sFasL revealed net benefit. The continuous NRI and IDI of sFasL were 0.36 (0.00-0.72, P=0.05) and 0.02 (-0.01-0.06, P=0.18), respectively. Conclusions Pleural fluid sFasL has moderate diagnostic accuracy for TPE.
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Affiliation(s)
- Xu-Hui Wen
- Department of Parasitology, The Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, China
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jian-Xun Wen
- Department of Medical Experiment Center, The Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, China
| | - Lan Mu
- Department of Parasitology, The Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, China
| | - Xi-Shan Cao
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Li Yan
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jin-Hong Huang
- Department of Pulmonary and Critical Care Medicine, Affiliated Changshu Hospital of Nantong University, Suzhou, China
| | - Hong Chen
- Department of Pulmonary and Critical Care Medicine, Affiliated Changshu Hospital of Nantong University, Suzhou, China
| | - Ting-Wang Jiang
- Department of Key Laboratory, Affiliated Changshu Hospital of Nantong University, Suzhou, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yan Niu
- Department of Medical Experiment Center, The Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, China
| | - Wen-Qi Zheng
- Department of Parasitology, The Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, China
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Huang JH, Chen H, Zhang ZC, Gu J, Yan L, Jiang MP, Zheng WQ, Hu ZD, Jiang TW. Age affects the diagnostic accuracy of the cancer ratio for malignant pleural effusion. BMC Pulm Med 2023; 23:198. [PMID: 37286973 DOI: 10.1186/s12890-023-02475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Cancer ratio (CR), which is defined as serum lactate dehydrogenase (LDH) to pleural fluid adenosine deaminase (ADA) ratio, has been reported to be a useful diagnostic marker for malignant pleural effusion (MPE). Whether its diagnostic accuracy is affected by age remains unknown. This study aimed to investigate the effects of age on the diagnostic accuracy of CR. METHODS The participants in this study were from a prospective cohort (SIMPLE cohort, n = 199) and a retrospective cohort (BUFF cohort, n = 158). All participants were patients with undiagnosed pleural effusion (PE). We used receiver operating characteristic (ROC) curves to evaluate the diagnostic accuracy of CR. The effect of age on the diagnostic accuracy of CR was investigated by adjusting the upper limit of age for participant enrolment. RESULTS Eighty-eight MPE patients were verified in the SIMPLE cohort, and thirty-five MPE patients were verified in the BUFF cohort. The AUCs of CR in the SIMPLE and BUFF cohorts were 0.60 (95% CI: 0.52-0.68) and 0.63 (95% CI: 0.54-0.71), respectively. In both cohorts, the AUCs of CR decreased with the advancement of age. CONCLUSION Age can affect the diagnostic accuracy of CR for MPE. CR has limited diagnostic value in older patients. KEY MESSAGE Cancer ratio is a promising diagnostic marker for malignant pleural effusion. This study revealed that its diagnostic accuracy decreased in older patients. Its diagnostic accuracy is overestimated by previous studies using tuberculosis and pneumonia patients as controls.
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Affiliation(s)
- Jin-Hong Huang
- Department of Pulmonary and Critical Care Medicine, the Affiliated Changshu Hospital of Nantong University, 215500, Changshu, China
| | - Hong Chen
- Department of Pulmonary and Critical Care Medicine, the Affiliated Changshu Hospital of Nantong University, 215500, Changshu, China
| | - Zhi-Cheng Zhang
- Department of Key Laboratory, the Affiliated Changshu Hospital of Nantong University, 215500, Changshu, China
| | - Jie Gu
- Department of Key Laboratory, the Affiliated Changshu Hospital of Nantong University, 215500, Changshu, China
| | - Li Yan
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Inner Mongolia Medical Universit, 010050, Hohhot, China
| | - Meng-Ping Jiang
- The Affiliated Hospital of Inner Mongolia Medical University, 010050, Hohhot, China
| | - Wen-Qi Zheng
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, 010050, Hohhot, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, 010050, Hohhot, China.
| | - Ting-Wang Jiang
- Department of Key Laboratory, the Affiliated Changshu Hospital of Nantong University, 215500, Changshu, China.
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