Key result
Pleural fluid sFasL demonstrates a 0.74 AUC for diagnosing tuberculous pleural effusion, underperforming ADA.
Why the study?
The diagnosis of tuberculous pleural effusion is challenging and the additional diagnostic value and net benefit of pleural fluid soluble Fas ligand compared to traditional markers remain unknown.
Does pleural fluid soluble Fas ligand (sFasL) provide additional diagnostic value compared to adenosine deaminase (ADA) for diagnosing tuberculous pleural effusion in patients with undiagnosed pleural effusion?
Observational (n=211)
Does pleural fluid soluble Fas ligand (sFasL) provide additional diagnostic value compared to adenosine deaminase (ADA) for diagnosing tuberculous pleural effusion in patients with undiagnosed pleural effusion?
Effect estimate: AUC 0.74 (95% CI 0.65-0.83)
Absolute Event Rate: 0.74% vs 0.8%
Pleural fluid sFasL demonstrates moderate diagnostic accuracy for tuberculous pleural effusion, though its AUC (0.74) is lower than that of the traditional marker ADA (0.80).
sFasL may add diagnostic value to ADA for TPE; leaves open net clinical benefit in undiagnosed effusions pending prospective validation.
Background: The diagnosis of tuberculous pleural effusion (TPE) is challenging for pulmonologists. Adenosine deaminase (ADA), interferon-gamma (IFN-γ), and interleukin-27 (IL-27) have some limitations for diagnosing TPE. Soluble Fas ligand (sFasL) had a high diagnostic value for TPE. However, it remains unknown: (I) whether sFasL has an additional diagnostic value to the traditional markers (e.g., ADA); (II) whether sFasL provides a net benefit in patients with undiagnosed pleural effusion; (III) factors affecting the diagnostic accuracy of sFasL for TPE. This study aimed to evaluate the additional diagnostic value and benefit of pleural fluid sFasL for TPE. Methods: We prospectively enrolled 211 patients with undiagnosed pleural effusion. The concentration of sFasL in pleural fluid was measured by an enzyme-linked immunosorbent assay (ELISA). The diagnostic accuracy and net benefit of sFasL and ADA for TPE were analyzed by a receiver operating characteristic (ROC) curve, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discriminant improvement (IDI). Results: The area under the ROC curves (AUCs) of sFasL and ADA were 0.74 (95% CI: 0.65-0.83) and 0.80 (95% CI: 0.71-0.90), respectively. The decision curve of sFasL revealed net benefit. The continuous NRI and IDI of sFasL were 0.36 (0.00-0.72, P=0.05) and 0.02 (-0.01-0.06, P=0.18), respectively. Conclusions: Pleural fluid sFasL has moderate diagnostic accuracy for TPE.
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Wen et al. (2023) conducted an observational in Tuberculous pleural effusion (n=211). Pleural fluid soluble Fas ligand (sFasL) vs. Adenosine deaminase (ADA) was evaluated on Diagnostic accuracy for tuberculous pleural effusion (AUC) (AUC 0.74, 95% CI 0.65-0.83). Pleural fluid soluble Fas ligand demonstrated moderate diagnostic accuracy for tuberculous pleural effusion with an AUC of 0.74 (95% CI 0.65-0.83), compared to 0.80 for ADA.
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