Key result
Combined pleural fluid ADA and IL-27 levels accurately differentiated tuberculous from non-tuberculous pleural effusions with an AUC of 0.9994, 100% sensitivity, and 98.28% specificity.
Why the study?
Patients with tuberculous pleural effusion or malignant pleural effusions frequently share similar pleural fluid profiles, creating a need for new diagnostic biomarkers.
Does combined pleural fluid ADA and IL-27 improve diagnostic accuracy for tuberculous pleural effusion in patients with exudative pleural effusions?
Cross-Sectional (n=88)
No
Does combined pleural fluid ADA and IL-27 improve diagnostic accuracy for tuberculous pleural effusion in patients with exudative pleural effusions?
Effect estimate: AUC 0.9994 (95% CI 0.9975-1.001)
p-value: p=<0.0001
Combined measurement of ADA and IL-27 in pleural fluid provides excellent diagnostic accuracy (100% sensitivity, 98.3% specificity) for differentiating tuberculous from non-tuberculous pleural effusions.
Should not yet change pleural effusion diagnostic pathways; leaves open prospective validation of combined ADA-IL-27 performance.
Patients with tuberculous pleural effusion (TPE) or malignant pleural effusions (MPE) frequently have similar pleural fluid profiles. New biomarkers for the differential diagnosis of TPE are required. We determined whether cytokine profiles in the PE of patients could aid the differential diagnosis of TPE. 30 patients with TPE, 30 patients with MPE, 14 patients with empyema (EMP) and 14 patients with parapneumonic effusion (PPE) were enrolled between Dec 2018 and 2019. The levels of interleukin (IL)-6, IL-18, IL-27, CXCL8, CCL-1 and IP-10 were determined in PE by ELISA along with measurements of adenosine deaminase (ADA). The best predictors of TPE were combined ADA.IL-27 [optimal cut-off value = 42.68 (10 3 U ng/l 2 ), sensitivity 100%, specificity 98.28%], ADA [cut off value 27.5 (IU/l), sensitivity 90%, specificity 96.5%] and IL-27 [cut-off value = 2363 (pg/ml), sensitivity 96.7%, specificity 98.3%, p ≤ 0.0001]. A high level of IL-6 [cut-off value = 3260 (pg/ml), sensitivity 100%, specificity 67.2%], CXCL8 [cut-off value = 144.5 (pg/ml), sensitivity 93.3%, specificity 58.6%], CCL1 [cut-off value = 54 (pg/ml), sensitivity 100%, specificity 70.7%] and IP-10 [cut-off value = 891.9 (pg/ml), sensitivity 83.3%, specificity 48.3%] were also predictive of TPE. High ADA.IL-27, ADA and IL-27 levels differentiate between TPE and non-TPE with improved specificity and diagnostic accuracy and may be useful clinically.
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Roofchayee et al. (2021) conducted a cross-sectional in Pleural Effusion (n=88). Combined ADA and IL-27 levels vs. Non-tuberculous pleural effusion was evaluated on Diagnostic accuracy (Area Under the Curve) for differentiating tuberculous from non-tuberculous pleural effusions (AUC 0.9994, 95% CI 0.9975-1.001, p=<0.0001). Combined pleural fluid ADA and IL-27 levels accurately differentiated tuberculous from non-tuberculous pleural effusions with an AUC of 0.9994, 100% sensitivity, and 98.28% specificity.
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