Key result
Total adenosine deaminase in pleural fluids effectively discriminated pleural exudates from transudates with an AUC of 0.820 (95% CI 0.751-0.877; P<0.001).
Why the study?
Does total adenosine deaminase (ADA) in pleural fluid accurately discriminate between pleural transudates and exudates in patients with pleural effusion syndrome?
Cohort (n=157)
Does total adenosine deaminase (ADA) in pleural fluid accurately discriminate between pleural transudates and exudates in patients with pleural effusion syndrome?
Effect estimate: AUC 0.820 (95% CI 0.751-0.877)
p-value: p=<0.001
Total adenosine deaminase in pleural fluid is a useful biomarker with high diagnostic accuracy for distinguishing pleural exudates from transudates.
May support ADA testing for pleural effusion classification; leaves open prospective validation before routine adoption.
Background. An initial step in the evaluation of patients with pleural effusion syndrome (PES) is to determine whether the pleural fluid is a transudate or an exudate. Objectives. To investigate total adenosine deaminase (ADA) as a biomarker to classify pleural transudates and exudates. Methods. An assay of total ADA in pleural fluids (P-ADA) was observed using a commercial kit in a population-based cohort study. Results. 157 pleural fluid samples were collected from untreated individuals with PES due to several causes. The cause most prevalent in transudate samples (21%, n = 33 / 157 ) was congestive heart failure (79%, 26/33) and that among exudate samples (71%, n = 124 / 157 ) was tuberculosis (28.0%, 44/124). There was no significant difference in the proportion of either sex between the transudate and exudate groups. The median values of P-ADA were significantly different ( P < 0.0001 ) between both total exudates (18.4 U/L; IQR, 9.85-41.4) and exudates without pleural tuberculosis (11.0 U/L; IQR, 7.25-19.75) and transudates (6.85; IQR, 2.67-11.26). For exudates, the AUC was 0.820 (95% CI, 0.751-0.877; P < 0.001 ), with excellent discrimination. The optimum cut-off point in the ROC curve was determined as the level that provided the maximum positive likelihood ratio (PLR; 14.64; 95% CI, 2.11-101.9) and was22.0 U/L. For transudates, the AUC was 0.8245 (95% CI, 0.7470-0.9020; P < 0.0001 ). Internal validation of the AUC after 1000 resamples was evaluated with a tolerance minor than 2%. The clinical utility was equal to 92% (95% CI, 0.84 to 0.96, P < 0.05 ).Conclusions. P-ADA is a useful biomarker for distinguishing pleural exudates from transudates.
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Maranhão et al. (2021) conducted a cohort in Pleural effusion syndrome (n=157). Total adenosine deaminase (P-ADA) was evaluated on Discrimination of pleural exudates (AUC 0.820, 95% CI 0.751-0.877, p=<0.001). Total adenosine deaminase in pleural fluids effectively discriminated pleural exudates from transudates with an AUC of 0.820 (95% CI 0.751-0.877; P<0.001).
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