The pleural fluid lactate dehydrogenase/adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusions

BMC Pulmonary Medicine

Research Article

Jianxing He¹  Jun Liu¹  Panxiao Shen²  Xiaohong Xie²  Jinlin Wang²  Yunxiang Zeng³ 

[1] Department of Cardiothoracic Surgery, Guangzhou, China;Department of Respiratory Disease, Guangzhou, China;Department of Respiratory Disease, Guangzhou, China;The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, Guangdong Province, China;

关键词: Pleural fluid;    Lactate dehydrogenase;    Adenosine deaminase;    Tuberculous pleural effusion;    Parapneumonic pleural effusion;   

DOI  :  10.1186/s12890-017-0526-z

 received in 2017-03-07, accepted in 2017-11-24,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAlthough 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.MethodsA 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.ResultsThe 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.ConclusionsThe 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.

【 授权许可】

CC BY   
© The Author(s). 2017