Key result
In older patients (>40 years), pleural IL-27 demonstrated excellent diagnostic accuracy for differentiating tuberculous from non-tuberculous pleural effusion, yielding an AUC of 0.976.
Why the study?
Does age influence the diagnostic accuracy of pleural ADA, IFN-γ, and IL-27 for tuberculous pleural effusion in adult patients?
Cohort (n=274)
Single-blind
Yes
Does age influence the diagnostic accuracy of pleural ADA, IFN-γ, and IL-27 for tuberculous pleural effusion in adult patients?
Effect estimate: AUC 0.976 (95% CI 0.932-0.995)
p-value: p=<0.001
Age influences the diagnostic accuracy of pleural biomarkers for tuberculous pleural effusion, with ADA being highly accurate in young patients (≤40 years) and IL-27 being superior in older patients (>40 years).
Age may affect diagnostic accuracy of pleural ADA, IFN-γ, and IL-27 for TPE; leaves open need for age-adjusted thresholds in prospective studies.
Background: Accurately diagnosing pleural effusion is a frequent and significant problem in clinical practice. We sought to evaluate the influence of age on the diagnostic values of pleural adenosine deaminase (ADA), interferon-gamma (IFN-γ), and interleukin 27 (IL-27) for tuberculous pleural effusion (TPE). Methods: Two hundred seventy-four consecutive adult patients with pleural effusion were selected from Beijing (154 patients) and Wuhan (120 patients) during the same period and their pleural fluid concentrations of ADA, IFN-γ, and IL-27 were tested. Biomarker performance was analyzed by standard receiver operating characteristic (ROC) curves according to different ages. Results: Data from the Beijing cohort showed that ADA, IFN-γ, and IL-27 could all accurately diagnose TPE in young patients (≤ 40 years of age). With a cutoff of 21.4 U/L, the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ADA for diagnosing TPE were 1.000 (95% confidence interval: 0.884–1.000), 100.0%, 100.0%, 100.0, and 100.0, respectively. In older patients (> 40 years of age), IL-27 and IFN-γ were excellent biomarkers for discriminating TPE versus non-TPE cases. With a cutoff of 591.4 ng/L, the AUC, sensitivity, specificity, PPV, and NPV of IL-27 for diagnosing TPE were 0.976 (95% confidence interval: 0.932–0.995), 96.3%, 99.0%, 96.3, and 99.0, respectively. Similar diagnostic accuracy among the three pleural biomarkers was validated in the Wuhan cohort. Conclusions: Among young patients, ADA is reliable for diagnosing TPE. Conversely, in older patients, IL-27 is an excellent biomarker to differentiate TPE versus non-TPE cases.
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Jiang et al. (2020) conducted a cohort in Pleural effusion (n=274). Pleural IL-27, ADA, and IFN-γ vs. Non-tuberculous pleural effusion was evaluated on Diagnostic accuracy (AUC) of IL-27 for tuberculous pleural effusion in patients >40 years (AUC 0.976, 95% CI 0.932-0.995, p=<0.001). In older patients (>40 years), pleural IL-27 demonstrated excellent diagnostic accuracy for differentiating tuberculous from non-tuberculous pleural effusion, yielding an AUC of 0.976.
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