ASSESSMENT OF PLEURAL FLUID NEOPTERIN LEVELS AND THEIR DIAGNOSTIC UTILITY IN DIFFERENTIATING MALIGNANT PLEURAL EFFUSIONS FROM TB PLEURAL EFFUSIONS

Abstract

SESSION TITLE: Tuesday Electronic Posters 3 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Tuberculosis and malignancy are two common causes of pleural effusion in the Indian setting. A variety of investigations are used to differentiate between these two causes of pleural effusions. Of these investigations, pleural fluid ADA is currently being used to differentiate tuberculous pleural effusions from effusions of other etiologies. In the current study we assessed Pleural fluid Neopterin levels in patients with pleural effusions resulting from tuberculosis and malignancy and estimated the sensitivity and specificity of Pleural fluid Neopterin as a marker for tuberculous pleural effusion. METHODS: A total of 80 patients (25% female,75% male) with pleural effusions (45% left sided, 46.3% right sided and 8.8% bilateral) presenting with various symptoms(fever 75%,cough 83.8%, chest pain 52.5%,shortness of breath 67.5%)were included in our study. Pleural fluid analysis and ADA levels were performed in all the patients. Pleural fluid Neopterin levels were assessed by ELISA. Pleural biopsy and bronchoscopy were then performed for confirmation of the etiology. RESULTS: Among the patients studied, the common etiologies for effusions were Tuberculosis(63.8%) and malignancy(33.8%).The mean ADA level in patients with tuberculous pleural effusion was 82.65 while the mean ADA in patients with malignancy was 52.67.The difference in the mean ADA is statistically significant(p<0.05). Similarly the mean Pleural fluid Neopterin levels in patients with tuberculous pleural effusions was 7.34 while the mean in malignant pleural effusions was 4.48,a difference which was statistically significant (p<0.05). The mean Glucose level was also significantly higher in malignant pleural effusion as compared to tuberculous pleural effusion (p<0.05). The sensitivity and specificity of Pleural fluid Neopterin levels were assessed using ROC curves and these were compared to ADA levels. The sensitivity of Pleural fluid Neopterin was 53.1% while specificity was 44.4% in our study. CONCLUSIONS: Pleural fluid Neopterin is a sensitive and specific marker for differentiation of tuberculous and malignant pleural effusion CLINICAL IMPLICATIONS: Estimation of pleural fluid neopterin levels is easy to perform and also has the advantage of being non invasive. Hence it is relevant in clinical practice particularly in regions where tuberculosis is the most common cause of pleural effusions. DISCLOSURES: No relevant relationships by Subhakar Kandi, source=Web Response No relevant relationships by Ramesh Kumar, source=Web Response No relevant relationships by Noorjahan Mohammed, source=Web Response No relevant relationships by nazia nousheen siddiqua, source=Web Response