A potential role for D-dimer in the diagnosis of tuberculous pleural effusion

Y. Shen, T. Yang, L. Jia, T. Wang, L. Chen, C. Wan, L. Wang, Y. Yan, Q. Yi

Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China and Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, China. yiqun_scu@126.com

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• Respiratory Medicine

BACKGROUND AND OBJECTIVES: Tuberculous pleural effusion (TPE) is associated with enhanced local fibrinolysis; however, its role in TPE has not been studied. The present study aims to investigate whether pleural D-dimer, a fibrinolysis marker, plays a diagnostic role for TPE.

PATIENTS AND METHODS: Patients with pleural effusion were recruited prospectively. All subjects underwent a standard thoracocentesis and pleural effusion samples were collected. The diagnosis of pleural effusion was based on clinical, radiological, bacteriological, and histopathological examinations. Pleural D-dimer levels were measured by immunonephelometry assay. The capacity of pleural D-dimer to differentiate TPE from non-TPE was assessed with receiver operating characteristic curve analyses.

RESULTS: A total of 87 patients with pleural effusion were included in the study (32 TPE cases and 55 non-TPE controls). Subjects with TPE showed a marked elevation of pleural D-dimer than those with other etiologies (1082.66±453.83 vs. 319.98±266.78 mg/L FEU, p < 0.05). The area under curve when pleural D-dimer was used to differentiate TPE from non-TPE was 0.928 (95% confidence interval: 0.878-979). With a cut-off value of 622.5 mg/L FEU, the sensitivity and specificity were 84.38% and 85.45%, respectively.

CONCLUSIONS: Pleural D-dimer levels are higher in TPE than other causes of pleural effusions. D-dimer might be useful as a simple, surrogate marker for TPE. Further studies are needed to confirm our findings.

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