Pleural fluid and plasma d-dimer levels in tuberculous pleurisy: their diagnostic value and relation with clinical parameters

Abstract

AimD-dimer is product of solid phase fibrin degradation and accepted as a marker of endogenous fibrinolysis. It has been reported that there is a relationship between pulmonary tuberculosis and hypercoagulable state. Clinicians may have difficulties in diagnosis of tuberculous pleurisy in endemic areas. In this study we aimed to investigate the diagnostic value of pleural fluid and plasma D-dimer levels and their correlation with other clinical and laboratory parameters in patients with tuberculous pleurisy.MethodsSixty four patients with pleural effusion, including tuberculous pleurisy (35 patients), malignant pleural effusion (9 patients), parapneumonic pleural effusion (7 patients), congestive heart failure (7 patients), nonspecific pleurisy (4 patients) and connective tissue disorder (2 patients), constituted the study population. Pleural fluid and plasma D-dimer levels, in addition, serum and pleural fluid adenosine deaminase, glucose, lactate dehydrogenase, total protein and albumin were quantified in all patients. The extent of pleural effusion in tuberculous pleurisy was assessed by radiologically.ResultsPleural fluid D-dimer levels were significantly differed in patients with tuberculous pleurisy (490.79±224.1 mcg/ml) from those in non-tuberculous pleural effusion (107.97±119.51 mcg/ml). In tuberculous group, there was a negative correlation (r=-0.473) between plasma and pleural fluid D-dimer levels. Plasma D-dimer levels showed a positive correlation (r=0.49) with pleural fluid glucose levels while the same parameter showed a negative correlation with pleural fluid adenosine deaminase levels (r=-0.45). Pleural fluid D-dimer levels correlated positively with serum lactate dehydrogenase (r=0.485) and negatively with pleural fluid/serum protein ratio and pleural fluid glucose levels (r=-0.341 and r=-0.449, respectively). Radiological pleural effusion score was correlated positively (r=0.642) with pleural fluid D-dimer levels in patients with tuberculous pleurisy. Diagnostic parameters of pleural fluid D-dimer were assessed as specificity: 90%, sensitivity: 74%, positive predictive value: 90%, negative predictive value: 74% and accuracy: 81%.ConclusionIn conclusion, pleural fluid and plasma D-dimer levels are increased in tuberculous pleurisy with respect to non-tuberculous effusions indicating hypercoagulable state in tuberculosis. We suggested that pleural fluid D-dimer quantification may have some contribution to diagnosis of tuberculous pleurisy.

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