Diagnostic Accuracy with Total Adenosine Deaminase as a Biomarker for Discriminating Pleural Transudates and Exudates in a Population-Based Cohort Study.

Bernardo Henrique Ferraz Maranhão,Joeber Bernardo Soares de Souza,Carmem Lucia Teixeira de Castro,Jorge Luiz Barillo,Cyro Teixeira da Silva Junior,Patricia Siqueira Silva,Roberto Stirbulov,Paulina Dumnicka

doi:10.1155/2021/6648535

Abstract

Background An initial step in the evaluation of patients with pleural effusion syndrome (PES) is to determine whether the pleural fluid is a transudate or an exudate. Objectives To investigate total adenosine deaminase (ADA) as a biomarker to classify pleural transudates and exudates. Methods An assay of total ADA in pleural fluids (P-ADA) was observed using a commercial kit in a population-based cohort study. Results 157 pleural fluid samples were collected from untreated individuals with PES due to several causes. The cause most prevalent in transudate samples (21%, n = 33/157) was congestive heart failure (79%, 26/33) and that among exudate samples (71%, n = 124/157) was tuberculosis (28.0%, 44/124). There was no significant difference in the proportion of either sex between the transudate and exudate groups. The median values of P-ADA were significantly different (P < 0.0001) between both total exudates (18.4 U/L; IQR, 9.85-41.4) and exudates without pleural tuberculosis (11.0 U/L; IQR, 7.25-19.75) and transudates (6.85; IQR, 2.67-11.26). For exudates, the AUC was 0.820 (95% CI, 0.751-0.877; P < 0.001), with excellent discrimination. The optimum cut-off point in the ROC curve was determined as the level that provided the maximum positive likelihood ratio (PLR; 14.64; 95% CI, 2.11-101.9) and was22.0 U/L. For transudates, the AUC was 0.8245 (95% CI, 0.7470-0.9020; P < 0.0001). Internal validation of the AUC after 1000 resamples was evaluated with a tolerance minor than 2%. The clinical utility was equal to 92% (95% CI, 0.84 to 0.96, P < 0.05).Conclusions P-ADA is a useful biomarker for distinguishing pleural exudates from transudates.

Highlights

An initial step in the evaluation of patients with pleural effusion syndrome (PES) is to determine whether the pleural fluid is a transudate or an exudate
Based on pathophysiology, pleural effusion is traditionally classified into two types: transudate and exudate [1,2,3]
An initial step in the evaluation of patients with PES is to determine whether the pleural fluid from a thoracentesis is a transudate or an exudate [3, 4]

Summary

Introduction

An initial step in the evaluation of patients with pleural effusion syndrome (PES) is to determine whether the pleural fluid is a transudate or an exudate. Pleural effusion syndrome (PES) is determined by the interaction of dynamic phenomena that affect systemic and pulmonary circulation, lymphatic drainage, and the movements of the chest wall in many thoracic and extrathoracic diseases. An initial step in the evaluation of patients with PES is to determine whether the pleural fluid from a thoracentesis is a transudate or an exudate [3, 4]. Maranhão and Silva Junior’s criterion can be used; it has shown a diagnostic yield comparable to that of the classical Light’s criteria but requires only total pleural proteins and lactate dehydrogenase in pleural fluid, without the need for serum sampling [3, 5,6,7]. Ideal biomarkers in pleural fluid or serum to diagnose transudates and exudates are not yet available

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Discussion

Conclusion