A study of the utility of lactate dehydrogenase, total proteins, and adenosine deaminase in the diagnosis of pleural exudates: A new statistical approach

Background: Pleural fluid (PF) may be transudative or exudative. Total protein estimation from PF is used to detect exudative pleural effusion. Objectives: To determine the role of new suggested criteria consisting of lactate dehydrogenase (LDH), total proteins (TP), and adenosine deaminase (ADA) in diagnosis of pleural effusion and differentiate it into transudative and exudative and also to compare it with Light’s criteria. Materials and Methods: This was a cross-sectional study comprising 101 patients with pleural effusion, classified by previously established criteria as transudates or exudates. The study was carried out in a 550-bedded tertiary-care, ruralbased, teaching hospital for 1 year. Diagnostic parameters mentioned in Light’s criteria were performed from PF and serum, whereas parameters of the new criteria used in our study (LDH, TP, and ADA) were performed from PF. Receiveroperating characteristic curve was used to determine the cutoffs, multiple parallel tests were applied to combine individual test markers to optimize diagnostic accuracy and sensitivity, and specificity and diagnostic accuracy for each test were calculated. Results: After using multiple parallel tests, the sensitivity, specificity, and accuracy of Light’s criteria for diagnosing exudates were 98.9%, 75%, and 95% and those for transudates were 95.29%, 80%, and 93%, respectively. Whereas for the proposed new criteria, sensitivity, specificity, and accuracy for diagnosing exudates were 98.81%, 93.75%, and 98% and those for transudates were 95.23%, 87.5%, and 94%, respectively. The accuracy of new criteria was comparable to that of Light’s criteria (p = 0.0018). Conclusion: From our study, it can be concluded that PF analysis of LDH, TP, and ADA has high sensitivity and specificity for diagnosing pleural effusions and can be used as useful markers to suggest exudative effusions

A synergistic role of ischemia modified albumin and high-sensitivity troponin T in the early diagnosis of acute coronary syndrome

Aim: The aim was to evaluate the role of high sensitivity troponin T and ischemia modified albumin (IMA) and in the early diagnosis of acute coronary syndrome (ACS). Materials and Methods: This was a cross-sectional study that comprised of 120 individuals of which 75 were cases and 45 healthy controls. On the basis of clinical history and 12-lead electrocardiogram, initial diagnosis of ACS was made in the cases. High sensitive cardiac troponin T (hs-cTnT) and IMA were measured in all the individuals. Results: Levels of IMA were significantly higher in patients of ACS as compared to those in control group (means: 101.83 [95% confidence interval (CI): 91.96-111.70] vs. 41.11 [95% CI: 38.55-43.67]). By taking the cut-off as >65.23 U/mL for IMA, which was obtained from receiver operating characteristic (ROC) curve, the sensitivity was 91.3%, specificity was 81.1%, positive predictive value (PPV) was 74.4%, and negative predictive value (NPV) was 93.9%. Positive likelihood ratio was 4.83 while negative likelihood ratio was 0.11, whereas the corresponding values in case of hs-cTnT were 95.6% (95% CI: 85.2-99.5), 61.3% (95% CI: 49.5-72.6), 59.7%, 95.8%, 2.47 and 0.07 by taking cut-off as >14 pg/mL. The area under the ROC curves (AUC) of IMA and hs-cTnT at 0-6 h were 0.932 (95% CI: 0.87-0.97, P < 0.001) and 0.797 (95% CI: 0.71-0.86, P < 0.001), respectively. The logistic model combining the two markers yielded sensitivity, specificity, PPV, and NPV of 95.7%, 81.1%, 88.6%, and 92.5% respectively. Conclusion: hs-cTnT and IMA may be useful tools for risk stratification of ACS and can be used together with better accuracy in the early diagnosis of ACS