Discrimination of exudative pleural effusions based on multiple biological parameters

Abstract

Pleural effusion is a common complication of various diseases. Conventional methods are not always capable of establishing the cause of pleural effusion, so alternative tests are needed. The aim of this study was to explore means of discriminating between different pleural effusion groups, malignant, parapneumonic and tuberculous, based on the combined function of seven biological markers.Adenosine deaminase (ADA), interferon-c, C-reactive protein (CRP), carcinoembryonic antigen, interleukin-6, tumour necrosis factor-a and vascular endothelial growth factor concentration levels were measured in pleural fluid from 45 patients with malignant, 15 with parapneumonic and 12 with tuberculous pleural effusion. Receiver operating characteristic curve analysis, multinomial logit modelling and canonical variate analysis were applied to discriminate the pleural effusion groups.The three groups could be discriminated successfully using the measured markers. The most important parameters for discrimination were ADA and CRP concentration levels. An individual with an ADA concentration level of .45 U?L -1 and a CRP concentration of ,4 mg?dL -1 was more likely to belong to the tuberculous pleural effusion group, whereas one with an ADA concentration level of ,40 U?L -1 and a CRP concentration of .6 mg?dL -1 was more likely to belong to the parapneumonic pleural effusion group, and one with a CRP concentration of ,4 mg?dL -1 to the malignant pleural effusion group. The combination of adenosine deaminase and C-reactive protein levels might be sufficient for discriminating between the three different groups of exudative pleural effusion: malignant, tuberculous and parapneumonic.

Use of Pleural Fluid C- Reactive Protein and comparison with Light’s criteria to differentiate Exudative from Transudative Pleural Effusions in Nepalese Population.

“…Using clinical diagnosis in this study the number of patients having exudative and transudative pleural effusion were 73 (85.04%) and 13 (15%) respectively. This is comparable with the most studies in pleural effusion were the number of exudates out proportion transudates by several folds [1,2,4,5,16,17,18].…”

Use of Pleural Fluid C- Reactive Protein and comparison with Light’s criteria to differentiate Exudative from Transudative Pleural Effusions in Nepalese Population.

“…Using clinical diagnosis in this study the number of patients having exudative and transudative pleural effusion were 73 (85.04%) and 13 (15%) respectively. This is comparable with the most studies in pleural effusion were the number of exudates out proportion transudates by several folds [1,2,4,5,16,17,18].…”

An Evaluation of Levels of C - reactive protein in Serum and Pleural Fluid of Pleural Effusion of Different Etiology

“…In the present study, in most cases of tuberculous pleural effusion the ADA levels were >40U/L and CRP levels >2mg/dl, in PPE the ADA levels were <40 U/L (except empyema cases) and CRP levels >6mg/dl, where as in both malignant and transudative and CRP levels <2mg/dl. The present study is in accordance with findings of Daniil et al (2007).…”

The Use of a Novel Quantitative Marker of Echogenicity of Pleural Fluid in Parapneumonic Pleural Effusions

“…The relationship of other biomarkers of pleural fluid with the HI index was also assessed in our study, revealing an interesting association of the HI levels with ADA values in patients with PPE. This result is consistent with evidence from other studies, supporting the correlation of the increasing ADA values in the progression of an uncomplicated to complicated PPE possibly due to high-intensity pleural inflammation [ 11 , 22 ].…”

Use of Pleural Fluid C- Reactive Protein and comparison with Light’s criteria to differentiate Exudative from Transudative Pleural Effusions in Nepalese Population.

“…Using clinical diagnosis in this study the number of patients having exudative and transudative pleural effusion were 73 (85.04%) and 13 (15%) respectively. This is comparable with the most studies in pleural effusion were the number of exudates out proportion transudates by several folds [1,2,4,5,16,17,18].…”

An Evaluation of Levels of C - reactive protein in Serum and Pleural Fluid of Pleural Effusion of Different Etiology

“…In the present study, in most cases of tuberculous pleural effusion the ADA levels were >40U/L and CRP levels >2mg/dl, in PPE the ADA levels were <40 U/L (except empyema cases) and CRP levels >6mg/dl, where as in both malignant and transudative and CRP levels <2mg/dl. The present study is in accordance with findings of Daniil et al (2007).…”

The Use of a Novel Quantitative Marker of Echogenicity of Pleural Fluid in Parapneumonic Pleural Effusions

“…The relationship of other biomarkers of pleural fluid with the HI index was also assessed in our study, revealing an interesting association of the HI levels with ADA values in patients with PPE. This result is consistent with evidence from other studies, supporting the correlation of the increasing ADA values in the progression of an uncomplicated to complicated PPE possibly due to high-intensity pleural inflammation [ 11 , 22 ].…”

Use of Pleural Fluid C- Reactive Protein and comparison with Light’s criteria to differentiate Exudative from Transudative Pleural Effusions in Nepalese Population.

“…Using clinical diagnosis in this study the number of patients having exudative and transudative pleural effusion were 73 (85.04%) and 13 (15%) respectively. This is comparable with the most studies in pleural effusion were the number of exudates out proportion transudates by several folds [1,2,4,5,16,17,18].…”

An Evaluation of Levels of C - reactive protein in Serum and Pleural Fluid of Pleural Effusion of Different Etiology

“…In the present study, in most cases of tuberculous pleural effusion the ADA levels were >40U/L and CRP levels >2mg/dl, in PPE the ADA levels were <40 U/L (except empyema cases) and CRP levels >6mg/dl, where as in both malignant and transudative and CRP levels <2mg/dl. The present study is in accordance with findings of Daniil et al (2007).…”

The Use of a Novel Quantitative Marker of Echogenicity of Pleural Fluid in Parapneumonic Pleural Effusions

“…The relationship of other biomarkers of pleural fluid with the HI index was also assessed in our study, revealing an interesting association of the HI levels with ADA values in patients with PPE. This result is consistent with evidence from other studies, supporting the correlation of the increasing ADA values in the progression of an uncomplicated to complicated PPE possibly due to high-intensity pleural inflammation [ 11 , 22 ].…”