Disorders of the Pleura: Disorders of the Pleura |

High Level of ADA in Pleural Effusion, Diagnostic Value of CEA, NSE, Amylase, Glucose, and Lactic Dehydrogenase for the Differential Diagnosis of Pleural Effusion FREE TO VIEW

Je Hun Kim; Chul Ho Oak; Maan Hong Jung; Tae Won Jang; Hyunseung Je; Jihoon Choi
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Kosin University, Busan, Korea (the Republic of)

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):558A. doi:10.1016/j.chest.2016.08.647
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SESSION TITLE: Disorders of the Pleura

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Increased ADA levels in pleural fluid are reminiscent of tuberculous pleurisy. In practice, values above 40 IU/L in practice present levels of sensitivity and specificity > 90%. But at times, we experience extremly high levels of ADA in pleural effusion not tuberculosis. The difficulty of distingushing tuberculous pleurisy between empyema based on high level of ADA in pleural efffusion has motivated the alternative diagnostic strategy. We have evaluated the diagnostic value of pleural glucose, lactic dehydrogenase (LDH), carcino-embryonic antigen (CEA), neuron-specific enolase (NSE), amylase and each pleural fluid/serum ratio.

METHODS: We studied all 103 patients admitted to Kosin university gospel hospital from 1/2010~12/2015 with confirmed pleural effusion with >60 ADA level. The differential diagnosis of pleural effusion was made using pleural fluid culture, TB-PCR, Tb-Interferon gamma or acid fast bacilli from pleural fluid, sputum, bronchowashing fluid and blood. In addtion, we analyzed CEA, NSE, amylase, glucose, LDH. For each biomarker we identified an opticmal cutpoint and used this to calculate sensitivity, specificity, and area under the curve(AUC).

RESULTS: 64 were men (62.1%) and 39 were women (37.9%), with an age average 53 years. Each groups divided were: 42(41%) Pulmonary tuberculosis with tuberculous pleurisy, 33(32%) tuberculous pleurisy without lung involvement, 25(24%) empyema, 3(3%) malignant. Pleural LDH was significantly higher in the empyema group compared to the tuberculosis group (2510.25 vs 1292.65 IU/L, p<0.05), whereas Pleural glucose was significantly lower in the empyema group compared to the tuberculosis group (42.63 vs 85.93 mg/dl, p<0.05). A cut-off pleural LDH 1871.5 IU/L has a senstivity of 83.3% and a specificity of 82.7%. Also, a cut-off pleural glucose 54 has 81.6% and 79.2%, respectively.

CONCLUSIONS: We were considered to test pleural LDH and pleural glulcose for tube thoracostomy. Futhermore, pleural LDH and glucose were helpful for the differential diganosis of pleural effusion.

CLINICAL IMPLICATIONS: Low ADA level is very helpful in excluding tuberculous pleurisy. But, In TB endemic country, high ADA level in pleural fluid needed distinguishing that was really tuberculosis or another infectious diseases. In our experience, high pleural LDH and low pleural glucose are indicative of other bacterial pleural disease.

DISCLOSURE: The following authors have nothing to disclose: Je Hun Kim, Chul Ho Oak, Maan Hong Jung, Tae Won Jang, Hyunseung Je, Jihoon Choi

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