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

David Núñez-Jurado1, Isabel Rodríguez-Martín1, Juan Miguel Guerrero1

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

Clinical and Experimental Medicine
|September 25, 2023
PubMed

Insights

Diagnosing pleural effusion (PE) can be complex. This study found the lactate dehydrogenase to adenosine deaminase (LDH/ADA) ratio effectively distinguishes parapneumonic PE from other types, aiding diagnosis.

Area of Science:

  • Pulmonology
  • Medical Diagnostics
  • Biomarker Research

Background:

  • Pleural effusion (PE) is a common condition requiring diagnosis via thoracentesis.
  • Elevated pleural fluid adenosine deaminase (ADA) levels can suggest tuberculosis but lack specificity.
  • Accurate differentiation of PE types is crucial for appropriate patient management.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of pleural fluid biomarkers for PE.
  • To propose a novel diagnostic strategy for PE, particularly in patients with high ADA levels.
  • To differentiate between parapneumonic (PPE), tuberculous (TPE), malignant (MPE), and miscellaneous PE.

Main Methods:

  • Retrospective analysis of 259 patients with PE and elevated pleural fluid ADA (>33 U/L).
  • Analysis of demographic data, clinical information, and pleural fluid biomarkers including ADA and lactate dehydrogenase (LDH).
  • Development of a diagnostic decision tree based on key biomarkers and their ratios.

Main Results:

  • The LDH/ADA ratio demonstrated high sensitivity (98.06%) and specificity (98.08%) in distinguishing PPE from non-PPE.
  • A decision tree incorporating LDH/ADA ratio, ADA levels, and mononuclear cell percentage achieved 89.96% overall accuracy.
  • The developed decision tree effectively differentiated between the four studied types of PE.

Conclusions:

  • The pleural fluid LDH/ADA ratio is a valuable tool for differentiating PPE from other PE types.
  • A novel decision tree utilizing LDH/ADA ratio, ADA, and mononuclear cell percentage offers high accuracy for PE diagnosis.
  • This diagnostic strategy can improve the clinical management of patients with pleural effusion.
Keywords:
ADA elevatedDifferential diagnosisLDH/ADA ratioPleural effusionPleural fluid biomarkers

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