Subject(s)
Algorithms , Lung Diseases/diagnosis , Spirometry , Humans , Reference Values , Reproducibility of ResultsABSTRACT
BACKGROUND AND OBJECTIVE: An updated standardization statement on measurement of DL(CO) was issued by the American Thoracic Society (ATS)/European Respiratory Society (ERS) Task Force in 2005. The aim of this study was to evaluate the effects of new recommendations on the success rate, test efficiency, measurement variability and reported results of DL(CO) testing. METHODS: We prospectively evaluated 55 Chinese patients without previous experience of the DL(CO) test in 2006. Performance and results of the test according to the ATS 1995 and ATS/ERS 2005 acceptability criteria were compared. RESULTS: Using the 2005 criteria, the success rate (maximum four trials) improved from 65% to 85% (change: 20%, 95% CI: 9-31%; P = 0.001). The test efficiency as measured by two-trial and three-trial success rates increased from 25% and 51% to 60% and 78%, respectively (both P < 0.0005). The measurement variability was defined as the mean of absolute differences between two acceptable trial results of DL(CO) for each patient. The means (SD) were 0.60 (0.53) and 0.53 (0.57) mL/min/mm Hg for the old and new criteria, respectively (P = 0.623). The mean DL(CO) decreased slightly by 0.5%, from 14.93 +/- 5.74 (SD) (old criteria) to 14.86 +/- 5.75 mL/min/mm Hg (new criteria) overall, with a mean difference (SD) of -0.07 (0.20) mL/min/mm Hg for the 36 subjects meeting both criteria (paired t-test, P = 0.048). CONCLUSIONS: Success rate and test efficiency for DL(CO) measurement were improved when the new recommendations were adopted. The effects on measurement variability and reported results were minimal.
Subject(s)
Carbon Monoxide/metabolism , Pulmonary Diffusing Capacity/standards , Respiratory Function Tests/standards , Adolescent , Adult , Aged , Aged, 80 and over , Child , China , Europe , Female , Humans , Male , Middle Aged , Prospective Studies , Societies, Medical , United StatesABSTRACT
OBJECTIVE: The aim of the present study was to evaluate the utility of serum and pleural fluid biomarkers for predicting residual pleural scarring (RPS) in tuberculous pleuritis. METHODOLOGY: A retrospective study of patients with pleural tuberculosis was performed. Demographic data, clinical parameters, haematological indices, serum and pleural fluid biochemistry and pleural effusion area were assessed for correlation with the extent of RPS. RESULTS: RPS was found in 41.4% of the 70 cases evaluated, with significant pleural scarring being present in 7.1%. It was more common in males (odds ratio 5.55). Among the variables studied, only the percentage reduction of the effusion after 2 weeks of treatment was found to independently predict the extent of RPS (r=-0.502, P<0.001). CONCLUSION: RPS was more common in males and the percentage reduction in pleural effusion on CXR after 2 weeks of treatment was found to be a useful predictor of RPS.
Subject(s)
Cicatrix/diagnostic imaging , Cicatrix/microbiology , Pleural Effusion/diagnostic imaging , Pleurisy/microbiology , Tuberculosis, Pleural/complications , Adolescent , Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Pleural Effusion/microbiology , Pleural Effusion/therapy , Pleurisy/diagnostic imaging , Pleurisy/therapy , Predictive Value of Tests , Radiography , Retrospective Studies , Sex Factors , Treatment Outcome , Tuberculosis, Pleural/diagnostic imaging , Tuberculosis, Pleural/therapyABSTRACT
OBJECTIVE: To assess the usefulness of interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) in the diagnosis and prediction of outcome of pleural tuberculosis. PATIENTS AND METHODS: Pleural fluid from 32 TB and 34 non-TB patients was sent for assay of IL-6, TNF-alpha and IFN-gamma. Clinical parameters at presentation and residual pleural scarring at completion of treatment were assessed for pleural TB cases. RESULTS: The pleural fluid Levels of IL-6, TNF-alpha and IFN-gamma in TB patients were significantly higher than those with non-TB effusions (P values of <0.001, 0.018 and <0.001, respectively by independent t-test). Utility of these cytokines for diagnosis of pleural TB was evaluated using receiver operating characteristic (ROC) curve analysis. The cut-off values for IL-6, TNF-alpha and IFN-gamma determined in this analysis were 4000, 4 and 60 pg/ml respectively, and their sensitivity and specificity were 90.6% and 76.5%, 90.6% and 79.4%, 100% and 100%, respectively. The pretreatment pleural fluid IL-6 levels had a positive correlation with the number of febrile days after treatment (Pearson correlation test: r=0.60, P=0.009). A negative correlation was found between the percentage reduction in pleural fluid cytokines after 2 weeks treatment and the extent of residual pleural scarring (IL-6: r=-0.62, P=0.041; TNF-alpha: r=-0.65, P=0.030; IFN-gamma: r=0.83, P=0.002). CONCLUSION: Pleural fluid IL-6, TNF-alpha and IFN-gamma assays are useful in the diagnosis of pleural TB. The initial IL-6 level correlates with the number of febrile days. The percentage change of cytokines after 2 weeks of treatment also helps to predict residual pleural scarring.
