Incidence, Aetiology and Clinical Features of Eosinophilic Pleural Effusion: A Retrospective Study

Li, Minfang; Zeng, Yue; Li, Yaqing; Jia, Dan; Chen, Sheng; Wang, Jinlin

doi:10.21203/rs.3.rs-712062/v1

Cited by 1 publication

(1 citation statement)

References 7 publications

(17 reference statements)

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“…In our study, many patients with autoimmune diseases showed eosinophil elevation in their pleural effusions. Eosinophilic pleural effusion, defined as a pleural effusion of at least 10% eosinophils within a white cell differential count, is commonly caused by trauma, infectious diseases, malignant tumours, and several medications, and autoimmune diseases with eosinophilic pleural effusion are rare [30][31][32]. Only four patients with autoimmune diseases in our study showed pleural fluid with eosinophil counts of ≥ 10%.…”

Section: Discussionmentioning

confidence: 62%

Characteristics of pleural effusion with a high adenosine deaminase level: a case–control study

et al. 2022

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Background Increased pleural fluid adenosine deaminase (ADA) is useful for diagnosing tuberculous pleurisy (TB), but high ADA levels are associated with other diseases. In this study, we compare various disease characteristics in patients with high-ADA pleural effusion. Methods We retrospectively collected data for 456 patients with pleural fluid ADA levels of ≥ 40 U/L from January 2012 to October 2021. Cases were classified as TB (n = 203), pleural infection (n = 112), malignant pleural effusion (n = 63), nontuberculous mycobacteria (n = 22), malignant lymphoma (ML) (n = 18), autoimmune diseases (n = 11), and other diseases (n = 27), and data were compared among those diseases. Predictive factors were identified by comparing data for a target disease to those for all other diseases. A diagnostic flowchart for TB was developed based on those factors. Results The most frequent disease was TB, though 60.0% of patients were diagnosed with other diseases. Median ADA levels in patients with TB were 83.1 U/L (interquartile range [IQR] 67.2–104.1), higher than those of patients with pleural infection (median 60.9 [IQR 45.3–108.0], p = 0.004), malignant pleural effusion (median 54.1 [IQR 44.8–66.7], p < 0.001), or autoimmune diseases (median 48.5 [IQR 45.9–58.2], p = 0.008), with no significant difference from NTM (p = 1.000) or ML (p = 1.000). Pleural fluid lactate dehydrogenase (LDH) levels of < 825 IU/L were beneficial for the diagnosis of TB. Neutrophil predominance or cell degeneration, white blood cell count of ≥ 9200/µL or C-reactive protein levels of ≥ 12 mg/dL helped in diagnosing pleural infection. Pleural fluid amylase levels of ≥ 75 U/L and a pleural fluid ADA/total protein (TP) ratio of < 14 helped in diagnosing malignant pleural effusion. High serum LDH and high serum/pleural fluid eosinophils helped in diagnosing ML and autoimmune diseases, respectively. The flowchart was comprised of the following three factors: pleural fluid LDH < 825 IU/L, pleural fluid ADA/TP of < 14, and neutrophil predominance or cell degeneration, which were decided by a decision tree. The diagnostic accuracy rate, sensitivity, and specificity for the diagnosis of TB were 80.9%, 78.8%, and 82.6%, respectively. Conclusion Cases involving high pleural fluid ADA levels should be investigated using several factors to distinguish TB from other diseases.

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Section: Discussionmentioning

confidence: 62%