Liyan Lin1,2, Shuguang Li3,4, Qiao Xiong5, Hui Wang6,7. 1. Department of Clinical Laboratory, Peking University People's Hospital, Xizhimen South Avenue No. 11, Beijing, 100044, China. 2. Department of Infectious Diseases and Immunology, Sydney Medical School, The University of Sydney, Sydney, 2006, Australia. 3. Department of Clinical Laboratory, Peking University People's Hospital, Xizhimen South Avenue No. 11, Beijing, 100044, China. sdu_lsg@126.com. 4. Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China. sdu_lsg@126.com. 5. School of Public Health, The University of Sydney, Sydney, 2006, Australia. 6. Department of Clinical Laboratory, Peking University People's Hospital, Xizhimen South Avenue No. 11, Beijing, 100044, China. wanghui@pkuph.edu.cn. 7. Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China. wanghui@pkuph.edu.cn.
Abstract
PURPOSE: Pleural effusion (PE) is a common clinical manifestation, and millions of people suffer from pleural disease. Herein, this retrospective study was performed to evaluate the biomarkers and ratios in serum and pleural fluid (PF) for the differential diagnosis of the multiple types of PE and search for a new diagnostic strategy for PE. METHODS: In-patients, who developed tuberculous PE (TPE), malignant PE (MPE), complicated parapneumonic effusion (CPPE), uncomplicated PPE (UPPE), or PE caused by connective tissue diseases (CTDs) and underwent thoracentesis at Peking University People's Hospital from November 2016 to April 2019, were included in this study. Eleven biomarkers and their ratios in serum and PF were investigated and compared between pairs of the different PE groups, and a decision-tree was developed. RESULTS: Totally 112 PE cases, including 25 MPE, 33 TPE, 19 CPPE, 27 UPPE, and 8 PE caused by CTDs, were reviewed. Biomarkers and ratios showed good diagnostic performance with high area under the curve values, sensitivities, and specificities for the differential diagnosis of the multiple types of PE. According to the decision-tree analysis, the combination of adenosine deaminase (ADA), serum albumin, serum lactate dehydrogenase, total protein, PF-LDH/ADA, and PF-LDH/TP provided the best predictive capacity with an overall accuracy of 84.8%; the sensitivity and specificity for TPE diagnosis were 100% and 98.7%, respectively. CONCLUSION: The biomarkers and ratios showed good diagnostic performance, and a decision-tree with an overall accuracy of 84.8% was developed to differentiate the five types of PE in clinical settings.
PURPOSE:Pleural effusion (PE) is a common clinical manifestation, and millions of people suffer from pleural disease. Herein, this retrospective study was performed to evaluate the biomarkers and ratios in serum and pleural fluid (PF) for the differential diagnosis of the multiple types of PE and search for a new diagnostic strategy for PE. METHODS: In-patients, who developed tuberculous PE (TPE), malignant PE (MPE), complicated parapneumonic effusion (CPPE), uncomplicated PPE (UPPE), or PE caused by connective tissue diseases (CTDs) and underwent thoracentesis at Peking University People's Hospital from November 2016 to April 2019, were included in this study. Eleven biomarkers and their ratios in serum and PF were investigated and compared between pairs of the different PE groups, and a decision-tree was developed. RESULTS: Totally 112 PE cases, including 25 MPE, 33 TPE, 19 CPPE, 27 UPPE, and 8 PE caused by CTDs, were reviewed. Biomarkers and ratios showed good diagnostic performance with high area under the curve values, sensitivities, and specificities for the differential diagnosis of the multiple types of PE. According to the decision-tree analysis, the combination of adenosine deaminase (ADA), serum albumin, serum lactate dehydrogenase, total protein, PF-LDH/ADA, and PF-LDH/TP provided the best predictive capacity with an overall accuracy of 84.8%; the sensitivity and specificity for TPE diagnosis were 100% and 98.7%, respectively. CONCLUSION: The biomarkers and ratios showed good diagnostic performance, and a decision-tree with an overall accuracy of 84.8% was developed to differentiate the five types of PE in clinical settings.