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Accurate diagnosis of the cause of a pleural effusion can be challenging.
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Analysis of soluble biomarkers from effusions may be a useful adjunctive.
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Ideal biomarkers should be both sensitive and specific to the disease state being examined and be available at the bedside.
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None of the many reported biomarkers for pleural infection have yet been shown to be more effective than pH in predicting which parapneumonic effusions are complicated.
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The value of pleural fluid tumor markers in diagnosing
Pleural Fluid Biomarkers: Beyond the Light Criteria
Section snippets
Key points
Biomarkers of HF
HF causes more pleural effusions than any other disease. The finding of a transudate by applying the Light criteria reinforces its diagnosis, because HF accounts for 80% of all transudates. However, HF-related effusions in patients who receive diuretics or have bloody fluids frequently meet the Light exudative criteria by a narrow margin.5 In addition, differentiating cardiac from noncardiac transudates requires the use of specific disease biomarkers.
Biomarkers of pleural infection
The terms pleural infection and parapneumonic effusions are used interchangeably, although one-fourth of pleural infection cases occur without a concurrent bacterial pneumonia. The typical patient with pleural bacterial infection presents with symptoms of pneumonia (ie, fever, chest pain, dyspnea, cough) along with leukocytosis, raised serum C-reactive protein (CRP) levels, and a chest radiograph showing the effusion and radiological lung infiltrates. However, patients may have a more indolent
Biomarkers of tuberculosis
The need for biomarkers in pleural tuberculosis (TB) is justified by the low yield of conventional microbiological studies caused by the paucity of Mycobacterium tuberculosis in pleural fluid, and the 6 to 8 weeks required to obtain results. For example, in a retrospective analysis of 214 patients with pleural tuberculosis, solid culture media for mycobacteria were positive in just 28% of sputum and 15% of pleural fluid samples.31 The respective figures for acid-fast bacilli staining, a more
Biomarkers of malignancy
The diagnosis of malignant pleural effusions is most easily established by showing malignant cells in the pleural space. However, pleural fluid cytology is positive in only 60% of cases, leading to the need for further diagnostic tests.15 The cytology is more likely to be positive with adenocarcinoma than squamous cell carcinoma or lymphoma. Moreover, it provides a definitive diagnosis of mesothelioma in only one-third of cases and a suspected diagnosis in a further 20%.42
Summary
Accurate diagnosis of the cause of a pleural effusion can be challenging. Analysis of soluble biomarkers from effusions may be a useful adjunctive.47 Ideal biomarkers should be sensitive and specific to the disease state being examined, and available at the bedside. These characteristics are met by the natriuretic peptide NT-proBNP and the enzyme ADA. Pleural fluid NT-proBNP levels more than 1500 pg/mL are practically diagnostic of HF, whereas an ADA activity greater than 35 to 40 U/L in the
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Cited by (50)
The diagnostic value of interleukin-36 cytokines in pleural effusions of varying etiologies
2023, Clinica Chimica ActaHepatic Hydrothorax and Congestive Heart Failure Induced Pleural Effusion
2021, Clinics in Chest MedicineCitation Excerpt :A pleural fluid NT-proBNP level greater than 1500 pg is shown to have a sensitivity of 94% and specificity of 91%, for diagnosing CHF-induced PE in a meta-analysis, although serum levels of NT-proBNP were also comparable with similar results.64 A serum NT-proBNP level greater than 1500 pgml−1 is diagnostic of cardiac-induced PE.65,66 However, unilateral effusion with atypical features, such as large unilateral effusions (occupying 2/3 of hemithorax) or presence of pleuritic chest pain or fever, warrants fluid analysis including microbiology and cytology.
Cell-free Mycobacterium tuberculosis DNA test in pleural effusion for tuberculous pleurisy: a diagnostic accuracy study
2020, Clinical Microbiology and InfectionCitation Excerpt :Nucleic acid amplification tests (NAATs), especially real-time quantitative PCR, have been increasingly applied to the rapid detection of the M. tuberculosis genome [19]. However, M. tuberculosis genomic DNA tests generally have poor sensitivity due to the paucity of pathogenic organisms in pleural effusion [20]. Therefore, it was supposed that detection of cell-free DNA in pleural effusion may improve TP diagnosis, and a previous study with small sample size conducted by our team showed potential value in TP diagnosis [21].
Infectious pleural pathology
2018, Medicine (Spain)Chronic pleural effusion: diagnostic protocol and treatment
2018, Medicine (Spain)Integrated semi-targeted metabolomics analysis reveals distinct metabolic dysregulation in pleural effusion caused by tuberculosis and malignancy
2018, Clinica Chimica ActaCitation Excerpt :Biomarkers like adenosine deaminase (ADA) and carcinoembryonic antigen (CEA) are often used but the performance seems to be variable. Other biomarkers specific for these two diseases have been investigated by immunological, proteomic and transcriptomic approaches [10–14]. However, metabolomic changes between TPE and MPE are not clear.
The author has no potential conflicts of interest.