Parameter
Tuberculous pleural effusion (TPE)
Non-tuberculous pleural effusion (non-TPE)
p
n = 44
n = 159
Age (years)
51.5 (35.5–71.5)
68 (58–77)
0.0001
Sex F/M
11/33
75/84
0.01a
Site of pleural effusion (left/right/bilateral)
23/21/0
62/94/3
NSa
Body temperature (°C)
38.5 (36.6–39.0)
36.6 (36.6–38.0)
<0.0001
Duration of symptoms (weeks)
4 (2–7)
3 (1–6)
NS
TST (mm)
12 (10–15)
0 (0–9)
<0.001
WBC (109/L)
6.8 (5.3–8.7)
9.6 (7.0–12.9)
<0.0001
Pleural fluid protein concentration (g/dL)
5.0 (4.6–5.9)
4.1 (3.0–4.6)
<0.0001
Pleural fluid/serum protein ratio
0.7 (0.7–0.8)
0.6 (0.5–0.7)
<0.0001
Pleural fluid LDH activity (IU/L)
1,078 (604–2,070)
778 (298–1,795)
<0.05
Pleural fluid/serum LDH ratio
2.5 (1.5–3.8)
1.3 (0.6–3.2)
<0.05
Pleural fluid total cell count (109/L)
1,700 (1,200–3,300)
1,300 (500–3,180)
NS
Pleural fluid lymphocyte percentage
93 (81–96)
63 (36–81)
<0.0001
Pleural fluid ADA (U/L)
58 (44–91)
5 (0–14)
<0.0001
Pleural fluid IFN-γ (pg/mL)
735 (311–1,000)
8 (8–8)
<0.0001
Pleural fluid IL-2sRα (pg/mL)
2,665 (2,065–4,025)
2,116 (1,353–3,514)
<0.05
Pleural fluid IP-10 (pg/mL)
31,660 (21,570–34,399)
1,303 (359–3,400)
<0.001
Pleural fluid IL-12p40 (pg/mL)
621 (392–981)
203 (83–364)
<0.001
Pleural fluid IL-18 (pg/mL)
463 (57–858)
62 (8–185)
<0.001
Pleural fluid TNF-α (pg/mL)
79 (53–194)
13 (5–24)
<0.001
Pleural fluid Fas-ligand (pg/mL)
86 (64–133)
21 (159–32)
<0.001
Pleural fluid human MDC (pg/mL)
753 (523–1,056)
3,631 (281–585)
<0.001
Pleural fluid IL-23 (pg/mL)
1.5 (0.7–3.5)
1.2 (0.1–2.0)
NS
Table 2 shows the diagnostic performance of various pleural fluid biomarkers differentiating between TPE and non-TPE. The highest diagnostic accuracy was found for IFN-γ. Interferon-induced-protein 10 and Fas-ligand showed only a slightly lower accuracy. AUC of four pleural fluid biomarkers (IFN-γ. IP-10, Fas-ligand, and ADA) was higher than 0.9. Very low diagnostic performance was demonstrated for pleural fluid IL-23, with its sensitivity and specificity below 30 and 60 %, respectively.
Table 2
Sensitivity, specificity, positive and negative predicted value, AUC, and cut-off values of different pleural fluid biomarkers discriminating between tuberculous pleural effusion (TPE) vs. non-tuberculous pleural effusion (non-TPE)
Pleural fluid parameter | Sensitivity | Specificity | PPV | NPV | AUC | Cut-off value |
|---|---|---|---|---|---|---|
Pleural fluid ADA (U/L) | 88.4 | 92.8 | 77.6 | 96.6 | 0.92 | 40.0 |
Pleural fluid IFN-γ (pg/mL) | 97.7 | 98.7 | 95.5 | 99.4 | 0.99 | 118.7 |
Pleural fluid IL-2sRα (pg/mL) | 79.1 | 48.4 | 29.6 | 89.4 | 0.63 | 2,047.7 |
Pleural fluid IP-10 (pg/mL) | 90.7 | 91.1 | 73.6 | 97.3 | 0.96 | 11,420.0 |
Pleural fluid IL-12p40 (pg/mL) | 87.2 | 72.6 | 45.9 | 95.5 | 0.83 | 296.0 |
Pleural fluid IL-18 (pg/mL) | 61.9 | 87.6 | 60.5 | 88.2 | 0.77 | 327.7 |
Pleural fluid TNF-α (pg/mL) | 89.7 | 79.3 | 58.3 | 96.0 | 0.87 | 31.6 |
Pleural fluid Fas-ligand (pg/mL) | 94.6 | 89.6 | 87.5 | 95.6 | 0.95 | 45.0 |
Pleural fluid human MDC (pg/mL) | 78.4 | 72.9 | 69.0 | 81.4 | 0.73 | 520.8 |
Pleural fluid IL-23 (pg/mL) | 29.7 | 58.3 | 35.5 | 51.9 | 0.39 | 0.7 |
Significant differences between patients with TPE and patients with non-tuberculous pleural exudates in some clinical and laboratory parameters still persisted after the exclusion of patients with pleural transudates (Table 3). Younger age, higher body temperature, and male predominance characterized patients with TPE as compared with patients with pleural exudates caused by other underlying diseases. No differences in pleural fluid IL-2sRα and IL-23 concentration were noted. However, the activity or concentration of the remaining pleural fluid biomarkers was significantly higher in TPE as compared with all other pleural exudates (Table 3).
Table 3
Comparison of clinical and laboratory variables in patients with tuberculous pleural effusion (TPE) vs. non-tuberculous pleural exudates.
Parameter | Tuberculous pleural effusion (TPE) | Non-tuberculous pleural exudates | P |
|---|---|---|---|
n = 44 | n = 129 | ||
Age (years) | 51.5 (35.5–71.5) | 66 (57–74) | 0.0008 |
Sex F/M | 11/33 | 64/65 | 0.004a |
Site of pleural fluid (left/right/bilateral) | 23/21/0 | 59/69/1 | NSa |
Body temperature (°C) | 38.5 (36.6–39.0) | 36.6 (36.6–38.0) | <0.001 |
Duration of symptoms (weeks) | 4 (2–7) | 3 (1–6) | NS |
TST (mm) | 12 (10–15) | 0 (0–10) | <0.01 |
WBC (109/L) | 6.8 (5.3–8.7) | 10.3 (7.8–13.7) | <0.0001 |
Pleural fluid protein concentration (g/dL) | 5.0 (4.6–5.9) | 4.3 (3.9–48.0) | <0.0001 |
Pleural fluid/serum protein ratio | 0.7 (0.7–0.8) | 0.6 (0.6–0.7) | <0.001 |
Pleural fluid LDH activity (IU/L) | 1,078 (604–2,070) | 1,000 (541–2,415) | NS |
Pleural fluid/serum LDH ratio | 2.5 (1.5–3.8) | 1.8 (0.9–4.0) | <0.0001 |
Pleural fluid total cell count (109/L) | 1,700 (1,200–3,300) | 1,730 (750–4,670) | NS |
Pleural fluid lymphocyte percentage | 93 (81–96) | 62 (27–79) | <0.0001 |
Pleural fluid ADA (U/L) | 58 (44–91) | 8 (2–16) | <0.0001 |
Pleural fluid IFNγ (pg/mL) | 735 (311–1,000) | 8 (8–8) | <0.0001 |
Pleural fluid IL-2sRα (pg/mL) | 2,665 (2,065–4,025) < div class='tao-gold-member'>
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