Diagnosis of parapneumonic pleural effusion with serum and pleural fluid Activin A

Zhou, Guanghui; Liu, Kan; Ji, Xiuhai; Fen, Yan; Gu, Yinjie; Ding, Hui

doi:10.1016/j.clinsp.2022.100133

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Sumário

Original articles • Clinics 77 • 2022 • https://doi.org/10.1016/j.clinsp.2022.100133 copy

Diagnosis of parapneumonic pleural effusion with serum and pleural fluid Activin A

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The aim is to evaluate the diagnostic value of Activin A levels in serum and pleural fluid on Parapneumonic Pleural Effusion (PPE).

Methods

The authors collected serum and pleural fluid from 86 PPE and 37 Non-PPE (NPPE) patients. Including Activin A, levels of biomarkers such as Lactate Dehydrogenase (LDH), Procalcitonin (PCT), and C-Reactive Protein (CRP) were measured. All factors were calculated for association with days after admission. The diagnostic potential of biomarkers on PPE was considered by Receiver Operating Characteristic (ROC) curve analysis.

Results

Levels of Activin A in serum and pleural fluid of PPE patients were significantly higher than those of the NPPE patients. Moreover, concentrations of Activin A in pleural fluid showed a more obvious relevant days after admission. ROC curve analysis found that Activin A in pleural fluid had AUCs of 0.899 with 93% sensitivity and 84% specificity for PPE diagnosis.

Conclusion

Activin A in pleural fluid correlated with disease severity could act to diagnose PPE.

Keywords
Activin A; Pleural fluid; Serum; Parapneumonia

Highlights

Higher concentrations of Activin A in pleural effusion were associated with days of admission in PPE patients.
Elevated levels of Activin A in pleural effusion exhibited 93% sensitivity and 84% specificity in the diagnosis of PPE.
Pleural fluid Activin A level had higher AUC and better accuracy in the diagnosis of PPE.

	PPE	NPPE	p-value
	n = 86	n = 37	p-value
Gender (male), n (%)	24 (27.9%)	13 (35.1%)	0.34
Age (years old)	62 (52, 76)	63 (51, 74)	0.65
Smoking	37 (43%)	20 (54%)	0.21
Fever episode, n (%)	48 (55.8%)	22 (59.5%)	0.18
Systolic blood pressure (mmHg)	164 (102, 196)	171 (112, 197)	0.23
Diastolic blood pressure (mmHg)	87 (78, 108)	92 (81, 120)	0.34
Pulse rate (times/minute)	92 (72, 121)	94 (63, 127)	0.42
Respiratory rate (times/minute)	17 (15, 22)	19 (17, 23)	0.37
Days of admission (days)	9 (7, 14)	13 (11, 17)	0.11
In hospital mortality, n (%)	4 (4.6%)	2 (5.4%)	0.28

	PPE	NPPE	p-value
	n = 86	n = 37
Serum
WBC (× 109/L)	16.1 (10.5, 20.4)	8.6 (4.3, 13.2)	0.005^a a p < 0.05.
n (%)	82.5 (72.1, 87.3)	77.6 (62.3, 83.6)	0.18
CRP (mg/L)	173 (137.3, 268.4)	64.2 (13.2, 121.8)	< 0.001^a a p < 0.05.
PCT (ng/mL)	0.38 (0.17, 2.97)	0.07 (0.03, 0.23)	< 0.001^a a p < 0.05.
LDH (U/L)	103 (78.6, 142.3)	110 (88.1, 178.2)	0.203
Activin A (ng/mL)	33.6 (9.31, 50.7)	7.82 (0.71, 17.11)	< 0.001^a a p < 0.05.
Pleural effusion
WBC (× 106/L)	2.35 (1.31, 10.21)	0.42 (0.11, 0.87)	< 0.001^a a p < 0.05.
n (%)	81.4 (57.2, 88.5)	11.4 (3.7, 24.8)	< 0.001^a a p < 0.05.
CRP (mg/L)	102 (85.6, 174.9)	32.7 (8.41, 82.44)	< 0.001^a a p < 0.05.
PCT (ng/mL)	0.33 (0.09, 1.02)	0.05(0.02, 0.13)	< 0.001^a a p < 0.05.
LDH (U/L)	326 (147, 628)	76.3 (48, 151.3)	< 0.001^a a p < 0.05.
Activin A (ng/mL)	27.1 (8.66, 30.3)	1.29 (0.33, 8.06)	< 0.001^a a p < 0.05.

	Serum						Pleural effusion
	WBC	n (%)	CRP	PCT	LDH	Actvin A	WBC	n (%)	CRP	PCT	LDH	Actvin A
r	-0.203	-0.34	-0.26	0.504	0.263	0.682	-0.121	-0.252	-0.092	0.466	0.358	0.852
p-value	0.392	0.28	0.274	0.013^a a p < 0.05	0.245	0.003^a a p < 0.05	0.613	0.351	0.03^a a p < 0.05	0.026^a a p < 0.05	0.121	< 0.001^a a p < 0.05

	AUC	p-value	95% Confidence Interval		Sensitivity	Specificity
			Lower	Upper
Serum
CRP	0.756	0.006^a a p < 0.05.	0.649	0.860	0.73	0.67
PCT	0.821	0.004^a a p < 0.05.	0.722	0.923	0.75	0.74
Activin A	0.862	0.002^a a p < 0.05.	0.733	0.950	0.89	0.81
Pleural effusion
CRP	0.813	0.003^a a p < 0.05.	0.711	0.906	0.84	0.74
PCT	0.782	0.001^a a p < 0.05.	0.662	0.883	0.86	0.82
Activin A	0.899	< 0.001^a a p < 0.05.	0.813	0.965	0.93	0.84

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[1] ⁎ Corresponding author. E-mail address: staff1179@yxph.com (Y. Gu), dh1350519@163.com (H. Ding).