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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cystatin C is an endogenous protease inhibitor that can be detected in serum and in biological fluids&#46; Its main clinical utility is as a marker in the study of impaired renal function&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> However&#44; it is known to have a role in the regulation of other diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> and this has led to a growing interest in its determination in several different pathologies&#44; including heart failure&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> cancer progression&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> immune disorders&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> and COPD prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The presence of cystatin C has also been described in pleural fluid&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> and it has been suggested that it may be a useful diagnostic marker in the study of the etiology of pleural effusion&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> However&#44; this possibility has not been assessed in any depth&#44; and the results are limited to a small number of patients&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of our study was to analyze cystatin C levels in pleural fluid&#44; and explore their potential contribution to the diagnostic evaluation of effusions&#46; For this purpose&#44; we carried out a prospective study in consecutive patients with pleural effusion undergoing diagnostic thoracentesis&#46; We collected the following data from each patient&#58; age&#44; sex&#44; and biochemical analysis of pleural fluid and blood&#46; Only the results obtained from the first thoracentesis were taken into account&#46; The study was approved by the Clinical Research Ethics Committee of our hospital&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study included 87 patients &#40;42 women&#44; 48&#37;&#41; with a mean &#40;&#177; SD&#41; age of 70 &#40;&#177; 14&#41; years&#46; Effusions comprised 21 &#40;24&#37;&#41; transudates and 66 exudates &#40;76&#37;&#41;&#46; Of the exudates&#44; 14 &#40;21&#37;&#41; were of infectious origin&#44; 21 &#40;32&#37;&#41; were due to other benign processes &#40;47&#37;&#41;&#44; and 31 were associated with malignant diseases&#46; We analyzed the level of cystatin C in pleural fluid and the cystatin C&#47;creatinine ratio to normalize values according to kidney function&#46; Results were compared using analysis of variance&#44; and the values of sensitivity&#44; specificity&#44; and goodness-of-fit were tested using the area under the receiving operating characteristic &#40;ROC&#41; curve&#46; A <span class="elsevierStyleItalic">P</span> value &#60;0&#46;05 was considered statistically significant&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the values of interest in the 3 groups &#40;transudates&#44; benign exudates&#44; and malignant exudates&#41;&#46; The differences between the different diagnostic groups did not reach statistical significance&#46; The areas under the curve for differentiating transudates and exudates and for differentiating benign exudates from malignant exudates were&#44; in all cases&#44; lower than 0&#46;70&#46; Cut-off values for sensitivity and specificity that would improve the results described could not be established for the conventional criteria or routinely used parameters&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">9&#44;10</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The determination of biochemical parameters in pleural fluid is a fundamental step in diagnostic studies and guides the initial diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">9&#44;11</span></a> In addition to the usual parameters for differentiating transudates from exudates&#44; for diagnosing tuberculosis&#44; or for determining the prognosis of parapneumonic effusions&#44; some determinations have been shown to be of great use because they are characteristic of certain specific etiologies&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">10&#44;12</span></a> The recent interest in cystatin C due to its role in various diseases and the initial description of cystatin C levels in pleural fluid justified a proper methodological assessment of its possible diagnostic utility&#46; Domej et al&#46; found that cystatin C values in pleural fluid could vary depending on the etiology of the effusion&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> In their pilot study&#44; the authors obtained higher concentrations of cystatin C in pleural fluid in effusions of infectious origin&#46; However&#44; their findings were limited to a small number of patients&#46; In our experience&#44; cystatin C values in pleural fluid &#40;direct or corrected according to renal function&#41; did not differ significantly among the different diagnostic groups&#46; In contrast to the findings of Domej et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> we did not obtain results that might suggest that the determination of these parameters would be of potential use in clinical practice&#46;</p></span>"
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                  \t\t\t\t">1&#46;96 &#40;&#177; 0&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;92 &#40;&#177; 1&#46;39&#41;&nbsp;\t\t\t\t\t\t\n
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Scientific Letter
Cystatin C in Pleural Effusion
Cistatina C en el derrame pleural
María José Soler-Semperea,
Corresponding author
majosoler1@hotmail.com

Corresponding author.
, Marina Pellicer-Masb, Beatriz Quevedo-Sánchezc, Eduardo García-Pachóna
a Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
b Análisis Clínicos, Hospital General Universitario de Elche, Elche, Alicante, Spain
c Unidad de Medicina Intensiva, Hospital General Universitario de Elche, Elche, Alicante, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cystatin C is an endogenous protease inhibitor that can be detected in serum and in biological fluids&#46; Its main clinical utility is as a marker in the study of impaired renal function&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> However&#44; it is known to have a role in the regulation of other diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> and this has led to a growing interest in its determination in several different pathologies&#44; including heart failure&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> cancer progression&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> immune disorders&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> and COPD prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The presence of cystatin C has also been described in pleural fluid&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> and it has been suggested that it may be a useful diagnostic marker in the study of the etiology of pleural effusion&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> However&#44; this possibility has not been assessed in any depth&#44; and the results are limited to a small number of patients&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of our study was to analyze cystatin C levels in pleural fluid&#44; and explore their potential contribution to the diagnostic evaluation of effusions&#46; For this purpose&#44; we carried out a prospective study in consecutive patients with pleural effusion undergoing diagnostic thoracentesis&#46; We collected the following data from each patient&#58; age&#44; sex&#44; and biochemical analysis of pleural fluid and blood&#46; Only the results obtained from the first thoracentesis were taken into account&#46; The study was approved by the Clinical Research Ethics Committee of our hospital&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study included 87 patients &#40;42 women&#44; 48&#37;&#41; with a mean &#40;&#177; SD&#41; age of 70 &#40;&#177; 14&#41; years&#46; Effusions comprised 21 &#40;24&#37;&#41; transudates and 66 exudates &#40;76&#37;&#41;&#46; Of the exudates&#44; 14 &#40;21&#37;&#41; were of infectious origin&#44; 21 &#40;32&#37;&#41; were due to other benign processes &#40;47&#37;&#41;&#44; and 31 were associated with malignant diseases&#46; We analyzed the level of cystatin C in pleural fluid and the cystatin C&#47;creatinine ratio to normalize values according to kidney function&#46; Results were compared using analysis of variance&#44; and the values of sensitivity&#44; specificity&#44; and goodness-of-fit were tested using the area under the receiving operating characteristic &#40;ROC&#41; curve&#46; A <span class="elsevierStyleItalic">P</span> value &#60;0&#46;05 was considered statistically significant&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the values of interest in the 3 groups &#40;transudates&#44; benign exudates&#44; and malignant exudates&#41;&#46; The differences between the different diagnostic groups did not reach statistical significance&#46; The areas under the curve for differentiating transudates and exudates and for differentiating benign exudates from malignant exudates were&#44; in all cases&#44; lower than 0&#46;70&#46; Cut-off values for sensitivity and specificity that would improve the results described could not be established for the conventional criteria or routinely used parameters&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">9&#44;10</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The determination of biochemical parameters in pleural fluid is a fundamental step in diagnostic studies and guides the initial diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">9&#44;11</span></a> In addition to the usual parameters for differentiating transudates from exudates&#44; for diagnosing tuberculosis&#44; or for determining the prognosis of parapneumonic effusions&#44; some determinations have been shown to be of great use because they are characteristic of certain specific etiologies&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">10&#44;12</span></a> The recent interest in cystatin C due to its role in various diseases and the initial description of cystatin C levels in pleural fluid justified a proper methodological assessment of its possible diagnostic utility&#46; Domej et al&#46; found that cystatin C values in pleural fluid could vary depending on the etiology of the effusion&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> In their pilot study&#44; the authors obtained higher concentrations of cystatin C in pleural fluid in effusions of infectious origin&#46; However&#44; their findings were limited to a small number of patients&#46; In our experience&#44; cystatin C values in pleural fluid &#40;direct or corrected according to renal function&#41; did not differ significantly among the different diagnostic groups&#46; In contrast to the findings of Domej et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> we did not obtain results that might suggest that the determination of these parameters would be of potential use in clinical practice&#46;</p></span>"
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                  \t\t\t\t">1&#46;96 &#40;&#177; 0&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;92 &#40;&#177; 1&#46;39&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;22&nbsp;\t\t\t\t\t\t\n
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ISSN: 15792129
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