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Diagnostic value of ferritin measurements in patients with pleural effusions

I W Chong, M S Lin, J J Hwang

    Gaoxiong Yi Xue Ke Xue Za Zhi = the Kaohsiung Journal of Medical Sciences
    |October 1, 1989
    PubMed

    Insights

    Pleural effusion ferritin levels showed significant differences between tuberculous and malignant effusions. However, ferritin was not valuable for differentiating malignant from nonmalignant effusions or exudates from transudates.

    Area of Science:

    • Pulmonology
    • Clinical Chemistry
    • Diagnostic Medicine

    Background:

    • Pleural effusions (PE) are a common clinical condition requiring accurate diagnosis.
    • Biochemical markers in pleural fluid are crucial for differentiating effusion types.
    • Ferritin, an iron storage protein, has been investigated for its diagnostic potential in various conditions.

    Purpose of the Study:

    • To evaluate the diagnostic utility of pleural effusion ferritin (PE-ferritin) measurements.
    • To assess PE-ferritin's ability to differentiate between malignant, tuberculous (TB), non-TB nonmalignant exudates, and transudates.
    • To compare PE-ferritin with other established pleural fluid markers.

    Main Methods:

    • Measurement of PE-ferritin levels in 59 patients with various types of pleural effusions.
    • Categorization of patients into four groups: non-TB nonmalignant exudates, TB effusions, malignant exudates, and transudates.
    • Comparison of PE-ferritin levels and PE/serum (PE/S) ferritin ratios across groups.
    • Correlation analysis with PE-lactate dehydrogenase (PE-LDH), serum ferritin (S-ferritin), and PE-protein.
    • Assessment of diagnostic accuracy for differentiating effusion types.

    Main Results:

    • A significant difference in mean PE-ferritin was observed between TB effusions (594 ng/ml) and malignant exudates (1286 ng/ml) (p<0.05).
    • PE-ferritin showed considerable overlap among exudative groups, rendering it ineffective for distinguishing malignant from nonmalignant exudates.
    • Diagnostic accuracy of PE-ferritin (86%) for exudate vs. transudate discrimination was inferior to PE-protein, PE-LDH, PE/S protein ratio, and PE/S LDH ratio (all 98%).
    • Using a PE-ferritin cutoff of ≥500 ng/ml to distinguish malignant from TB effusions yielded 79% sensitivity, 57% specificity, and 71% accuracy.

    Conclusions:

    • Pleural effusion ferritin is not a reliable marker for differentiating malignant from nonmalignant pleural effusions.
    • PE-ferritin is less accurate than other biochemical markers in distinguishing exudates from transudates.
    • While PE-ferritin may offer some discriminatory power between malignant and TB effusions, its clinical utility is limited by moderate specificity.

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