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LDH/ADA ratio in pleural fluid for the diagnosis of infectious pleurisy

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Abstract

Pleural effusion (PE) is a common medical concern, often requiring thoracentesis for a definitive diagnosis. An elevated pleural fluid adenosine deaminase (ADA) may indicate tuberculosis, but this is not always the case. This study aimed to evaluate the accuracy of biomarkers determined in pleural fluid and propose a new diagnostic strategy for PE in patients with high levels of ADA in pleural fluid. This retrospective analysis studied patients with PE who received thoracentesis for the first time with an ADA level of > 33 U/L in the pleural fluid analysis at two tertiary hospitals from March 2019 to March 2023. Demographic and clinical data, as well as pleural fluid biomarkers and their ratios, were studied and compared between different PE groups, and a decision tree was developed. During the study period, 259 patients were enrolled, with four different types of PE: parapneumonic (PPE) 155, tuberculosis (TPE) 41, malignant (MPE) 50, and miscellaneous 13. Biomarkers and their ratios performed well in the differential diagnosis of PE, with the LDH/ADA ratio distinguishing between PPE and non-PPE with sensitivity and specificity of 98.06% and 98.08%, respectively. The combination of LDH/ADA ratio, ADA, and mononuclear cell percentage was identified as important factors for creating a decision tree with an overall accuracy of 89.96%. The pleural fluid LDH/ADA ratio was a useful diagnostic for distinguishing PPE from non-PPE, and a decision tree with an accuracy of 89.96% was created to differentiate the four forms of PE in clinical situations.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Clinical Biochemistry, Virgen del Rocío University Hospital, Manuel Siurot Avenue, 41013, Seville, Spain

    David Núñez-Jurado, Isabel Rodríguez-Martín & Juan Miguel Guerrero

  2. Department of Clinical Biochemistry, Puerto Real University Hospital, 1St Floor. Romería Street 7, 11510, Cádiz, Spain

    José Diego Santotoribio

Authors
  1. David Núñez-Jurado
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  2. Isabel Rodríguez-Martín
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  3. Juan Miguel Guerrero
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  4. José Diego Santotoribio
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Contributions

Ph.D. DNJ: Conceptualization, data curation, formal analysis, methodology, investigation, writing—original draft, writing-review & editing. Ph.D. IRM: Data curation, formal analysis, writing—original draft. Ph.D. JMG-M: Writing—review & editing. Ph.D. JD. Santotoribio: Data curation, investigation, supervision, validation, writing—review & editing. All authors read and approved the final manuscript.

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Correspondence to José Diego Santotoribio.

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Núñez-Jurado, D., Rodríguez-Martín, I., Guerrero, J.M. et al. LDH/ADA ratio in pleural fluid for the diagnosis of infectious pleurisy. Clin Exp Med 23, 5201–5213 (2023). https://doi.org/10.1007/s10238-023-01194-y

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