Hyaluronic Acid concentration in pleural fluid: diagnostic aid for tuberculous pleurisy

Our plain-English summary of Hyaluronic Acid concentration in pleural fluid: diagnostic aid for tuberculous pleurisy, by Y. Yoshino, Y. Wakabayashi, K. Seo, et al (Journal of Clinical Medicine Research, 2015).

The study

• Authors: Y. Yoshino, Y. Wakabayashi, K. Seo, I. Koga, T. Kitazawa, Y. Ota
• Journal: Journal of Clinical Medicine Research
• Published: 2015;7(1):41-4
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: A high concentration of hyaluronic acid in pleural fluid is suggestive of malignant mesothelioma. However, a relatively high concentration of hyaluronic acid was also seen in the pleural fluid of patients with benign inflammatory diseases. To show the utility of measuring hyaluronic acid levels in pleural fluid to diagnose tuberculous pleurisy, we compared the clinical features and levels of hyaluronic acid in the pleural fluid of patients with and without tuberculous pleurisy.

Methods: We enrolled 27 patients with infective pleurisy admitted at Teikyo University Hospital from January 2010 to December 2013. Ten patients were diagnosed with tuberculous pleurisy, and 17 with non-tuberculous pleurisy. We reviewed the clinical features and data of all 27 patients and compared the two groups. We analyzed and compared the concentration of hyaluronic acid and adenosine deaminase in their pleural fluid.

Results: Patients with tuberculous pleurisy tended to have significantly higher concentrations of hyaluronic acid and adenosine deaminase in their pleural fluid (tuberculous pleurisy patients vs. other infective pleurisy patients: hyaluronic acid (× 10(3) ng/mL); 42.9 ± 23.3 vs. 16.8 ± 17.9, P = 0.003, adenosine deaminase (IU/L); 89.7 ± 33.3 vs. 74.0 ± 90.9, P = 0.032). Receiver operating characteristic analysis revealed no significant difference in the area under the curve of hyaluronic acid and adenosine deaminase volumes in pleural fluid, suggesting their equivalent value as major diagnostic tools for tuberculosis pleurisy.

Conclusions: Hyaluronic acid concentration in pleural fluid can be a valuable tool for the diagnosis of tuberculous pleurisy.

In plain English

This study did not examine asbestos exposure or mesothelioma. It tested whether hyaluronic acid, a substance in the fluid around the lungs (pleural fluid), could help diagnose pleurisy caused by tuberculosis. The authors looked back at adult patients with infective pleurisy admitted to Teikyo University Hospital in Tokyo, Japan, from January 2010 to December 2013. Of 133 patients, 27 were analyzed: 10 with tuberculous pleurisy and 17 with other infective pleurisy. Patients with a history of respiratory malignancy or rheumatoid arthritis were excluded. Hyaluronic acid averaged 42.9 thousand ng/mL (standard deviation 23.3) in the tuberculous group and 16.8 thousand ng/mL (standard deviation 17.9) in the other group (P = 0.003). Adenosine deaminase, the test currently relied on, averaged 89.7 versus 74.0 IU/L (P = 0.032). The authors found no significant difference between the two tests in overall diagnostic accuracy. The authors concluded that hyaluronic acid might be a diagnostic aid for tuberculous pleurisy. They noted that the study was retrospective, at a single center and small, and that a larger prospective study is required.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective, single-center study comparing patients with and without tuberculous pleurisy
• Who was studied: Adult patients (over 18 years) with infective pleurisy admitted to Teikyo University Hospital, Tokyo, Japan, January 2010 to December 2013. Of 133 patients, 33 met the inclusion criteria, 6 were excluded for histories of respiratory malignant disease, and 27 were analyzed: 10 with tuberculous pleurisy and 17 with non-tuberculous infective pleurisy.
• Exposure: No asbestos exposure was studied. The groups were defined by tuberculous versus non-tuberculous infective pleurisy. Hyaluronic acid and adenosine deaminase were measured in pleural fluid. Patients with respiratory malignancy, including malignant mesothelioma, and patients with rheumatoid arthritis were excluded.
• Main results:
  • Pleural fluid hyaluronic acid (in thousands of ng/mL): 42.9 ± 23.3 in tuberculous pleurisy patients vs 16.8 ± 17.9 in non-tuberculous patients, P = 0.003
  • Pleural fluid adenosine deaminase (IU/L): 89.7 ± 33.3 in tuberculous pleurisy patients vs 74.0 ± 90.9 in non-tuberculous patients, P = 0.032
  • No significant difference in area under the ROC curve between hyaluronic acid and adenosine deaminase
  • Optimal hyaluronic acid cut-off of 24,950 ng/mL: sensitivity 0.80000, specificity 0.88235
  • Optimal adenosine deaminase cut-off of 51.9 IU/L: sensitivity 0.90000, specificity 0.64706
  • Age also differed between the groups: 57.1 ± 20.6 years in tuberculous patients vs 79.7 ± 11.5 years in non-tuberculous patients, P = 0.032
• The authors' conclusion: The authors concluded that measuring hyaluronic acid in pleural fluid might be a diagnostic aid for tuberculous pleurisy, and that a larger prospective study is required to confirm their findings.
• Limitations the authors state:
  • Retrospective, single-center study
  • Small sample size, because only hospitalized adult patients with infective pleurisy who met the criteria were enrolled
  • The duration of inflammation could not be calculated

Topics

Medical terms in this study, explained in our Lexicon: Hyaluronic Acid, Tuberculous pleurisy, Mesothelioma, Pleurisy.

Related studies

• Hyaluronic acid in the pleural fluid of patients with malignant pleural mesothelioma — N. Fujimoto, K. Gemba, et al. (2013)
• Utility of hyaluronic acid in pleural fluid for differential diagnosis of pleural effusions: likelihood ratios for malignant mesothelioma — S. Atagi, M. Ogawara, et al. (1997)
• Mesothelioma of the peritoneum; a case report in which the ascitic fluid contained hyaluronic acid — S. Dvoskin (1954)
• Pseudomesotheliomatous Carcinoma with a High Pleural Hyaluronic Acid Concentration Arising from a Primary Esophageal Squamous Cell Carcinoma — T. Shirahata, T. Takeshita, et al. (2019)
• Serum mesothelin has a higher diagnostic utility than hyaluronic acid in malignant mesothelioma — B. Grigoriu, B. Chahine, et al. (2009)
• Diagnostic method for malignant pleural effusion distinguishing malignant mesothelioma from lung cancer using pleural carcinoembryonic antigen and hyaluronic acid levels — T. Saraya, K. Ohkuma, et al. (2022)

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