{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T22:59:53Z","timestamp":1785106793531,"version":"3.55.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":67,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"Inner Mongolia Medical University Zhiyuan Talent Project","award":["ZY20243120"],"award-info":[{"award-number":["ZY20243120"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-026-53563-8","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:28:00Z","timestamp":1779362880000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined carcinoembryonic antigen, carbohydrate antigen 50, and neutrophil gelatinase-associated lipocalin distinguish benign and malignant pleural effusions: a Bayesian analysis"],"prefix":"10.1038","volume":"16","author":[{"given":"Su-Na","family":"Cha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Niu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Xun","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu-Lei","family":"Hao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Jie","family":"Hou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya-Nan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Qi","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-De","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"53563_CR1","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.arbres.2013.11.007","volume":"50","author":"JM Porcel","year":"2014","unstructured":"Porcel, J. M., Esquerda, A., Vives, M. & Bielsa, S. Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses. Arch. Bronconeumol. 50, 161\u2013165. https:\/\/doi.org\/10.1016\/j.arbres.2013.11.007 (2014).","journal-title":"Arch. Bronconeumol."},{"key":"53563_CR2","doi-asserted-by":"publisher","first-page":"e2120306","DOI":"10.1001\/jamanetworkopen.2021.20306","volume":"4","author":"P Tian","year":"2021","unstructured":"Tian, P. et al. Prevalence, Causes, and Health Care Burden of Pleural Effusions Among Hospitalized Adults in China. JAMA Netw. Open. 4, e2120306. https:\/\/doi.org\/10.1001\/jamanetworkopen.2021.20306 (2021).","journal-title":"JAMA Netw. Open."},{"issue":"Suppl 2","key":"53563_CR3","doi-asserted-by":"publisher","first-page":"ii32","DOI":"10.1136\/thx.2010.136994","volume":"65","author":"ME Roberts","year":"2010","unstructured":"Roberts, M. E., Neville, E., Berrisford, R. G., Antunes, G. & Ali, N. J. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax 65 (Suppl 2), ii32\u201340. https:\/\/doi.org\/10.1136\/thx.2010.136994 (2010).","journal-title":"Thorax"},{"key":"53563_CR4","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1111\/resp.13837","volume":"25","author":"JC Quek","year":"2020","unstructured":"Quek, J. C., Tan, Q. L., Allen, J. C. & Anantham, D. Malignant pleural effusion survival prognostication in an Asian population. Respirology 25, 1283\u20131291. https:\/\/doi.org\/10.1111\/resp.13837 (2020).","journal-title":"Respirology"},{"key":"53563_CR5","doi-asserted-by":"publisher","first-page":"377","DOI":"10.3238\/arztebl.2019.0377","volume":"116","author":"B Jany","year":"2019","unstructured":"Jany, B. & Welte, T. Pleural Effusion in Adults-Etiology, Diagnosis, and Treatment. Dtsch. Arztebl Int. 116, 377\u2013386. https:\/\/doi.org\/10.3238\/arztebl.2019.0377 (2019).","journal-title":"Dtsch. Arztebl Int."},{"key":"53563_CR6","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1136\/thoraxjnl-2021-217959","volume":"78","author":"S Kassirian","year":"2023","unstructured":"Kassirian, S. et al. Diagnostic sensitivity of pleural fluid cytology in malignant pleural effusions: systematic review and meta-analysis. Thorax 78, 32\u201340. https:\/\/doi.org\/10.1136\/thoraxjnl-2021-217959 (2023).","journal-title":"Thorax"},{"key":"53563_CR7","doi-asserted-by":"publisher","unstructured":"Kim, V. & Aaron, S. D. What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement. Eur. Respir. J. 52 https:\/\/doi.org\/10.1183\/13993003.01261-2018 (2018).","DOI":"10.1183\/13993003.01261-2018"},{"key":"53563_CR8","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.3978\/j.issn.2072-1439.2015.01.36","volume":"7","author":"G Dixon","year":"2015","unstructured":"Dixon, G., de Fonseka, D. & Maskell, N. Pleural controversies: image guided biopsy vs. thoracoscopy for undiagnosed pleural effusions? J. Thorac. disease. 7, 1041\u20131051. https:\/\/doi.org\/10.3978\/j.issn.2072-1439.2015.01.36 (2015).","journal-title":"J. Thorac. disease"},{"key":"53563_CR9","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1080\/10408363.2022.2158779","volume":"60","author":"XS Cao","year":"2023","unstructured":"Cao, X. S., Zheng, W. Q. & Hu, Z. D. Diagnostic value of soluble biomarkers for parapneumonic pleural effusion. Crit. Rev. Clin. Lab. Sci. 60, 233\u2013247. https:\/\/doi.org\/10.1080\/10408363.2022.2158779 (2023).","journal-title":"Crit. Rev. Clin. Lab. Sci."},{"key":"53563_CR10","doi-asserted-by":"publisher","first-page":"3142","DOI":"10.21037\/jtd-24-219","volume":"16","author":"KJ Goh","year":"2024","unstructured":"Goh, K. J. et al. Diagnostic value and safety of medical thoracoscopy in undiagnosed pleural effusions-a prospective observational cohort study. J. Thorac. disease. 16, 3142\u20133151. https:\/\/doi.org\/10.21037\/jtd-24-219 (2024).","journal-title":"J. Thorac. disease"},{"key":"53563_CR11","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1515\/cclm-2022-0844","volume":"61","author":"WQ Zheng","year":"2023","unstructured":"Zheng, W. Q. & Hu, Z. D. Pleural fluid biochemical analysis: the past, present and future. Clin. Chem. Lab. medicine: CCLM \/ FESCC. 61, 921\u2013934. https:\/\/doi.org\/10.1515\/cclm-2022-0844 (2023).","journal-title":"Clin. Chem. Lab. medicine: CCLM \/ FESCC"},{"key":"53563_CR12","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.21037\/tlcr-24-68","volume":"13","author":"SN Cha","year":"2024","unstructured":"Cha, S. N. et al. Pleural carbohydrate antigen 50 and malignant pleural effusion: a prospective, double-blind diagnostic accuracy test. Transl Lung Cancer Res. 13, 1061\u20131068. https:\/\/doi.org\/10.21037\/tlcr-24-68 (2024).","journal-title":"Transl Lung Cancer Res."},{"key":"53563_CR13","doi-asserted-by":"publisher","first-page":"2077","DOI":"10.1111\/1759-7714.14996","volume":"14","author":"DN Yang","year":"2023","unstructured":"Yang, D. N. et al. Long-term stability of pleural fluid carcinoembryonic antigen and its effect on the diagnostic accuracy for malignant pleural effusion. Thorac. Cancer. 14, 2077\u20132084. https:\/\/doi.org\/10.1111\/1759-7714.14996 (2023).","journal-title":"Thorac. Cancer"},{"key":"53563_CR14","doi-asserted-by":"publisher","first-page":"10425","DOI":"10.1016\/S0021-9258(18)82217-7","volume":"268","author":"L Kjeldsen","year":"1993","unstructured":"Kjeldsen, L., Johnsen, A. H., Sengel\u00f8v, H. & Borregaard, N. Isolation and primary structure of NGAL, a novel protein associated with human neutrophil gelatinase. J. Biol. Chem. 268, 10425\u201310432 (1993).","journal-title":"J. Biol. Chem."},{"key":"53563_CR15","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1186\/s13054-022-04223-6","volume":"26","author":"HC Pan","year":"2022","unstructured":"Pan, H. C. et al. Comparative accuracy of biomarkers for the prediction of hospital-acquired acute kidney injury: a systematic review and meta-analysis. Crit. Care. 26, 349. https:\/\/doi.org\/10.1186\/s13054-022-04223-6 (2022).","journal-title":"Crit. Care"},{"key":"53563_CR16","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1016\/s0140-6736(05)74811-x","volume":"365","author":"J Mishra","year":"2005","unstructured":"Mishra, J. et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 365, 1231\u20131238. https:\/\/doi.org\/10.1016\/s0140-6736(05)74811-x (2005).","journal-title":"Lancet"},{"key":"53563_CR17","doi-asserted-by":"publisher","unstructured":"Bauvois, B. & Susin, S. A. Revisiting Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Cancer: Saint or Sinner? Cancers (Basel). 10 https:\/\/doi.org\/10.3390\/cancers10090336 (2018).","DOI":"10.3390\/cancers10090336"},{"key":"53563_CR18","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.bbcan.2012.03.008","volume":"1826","author":"S Chakraborty","year":"2012","unstructured":"Chakraborty, S., Kaur, S., Guha, S. & Batra, S. K. The multifaceted roles of neutrophil gelatinase associated lipocalin (NGAL) in inflammation and cancer. Biochim. Biophys. Acta. 1826, 129\u2013169. https:\/\/doi.org\/10.1016\/j.bbcan.2012.03.008 (2012).","journal-title":"Biochim. Biophys. Acta"},{"key":"53563_CR19","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/b978-0-12-800263-6.00004-5","volume":"64","author":"G Lippi","year":"2014","unstructured":"Lippi, G., Meschi, T., Nouvenne, A., Mattiuzzi, C. & Borghi, L. Neutrophil gelatinase-associated lipocalin in cancer. Adv. Clin. Chem. 64, 179\u2013219. https:\/\/doi.org\/10.1016\/b978-0-12-800263-6.00004-5 (2014).","journal-title":"Adv. Clin. Chem."},{"key":"53563_CR20","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.canlet.2009.05.027","volume":"288","author":"D Bolignano","year":"2010","unstructured":"Bolignano, D. et al. Neutrophil gelatinase-associated lipocalin (NGAL) in human neoplasias: a new protein enters the scene. Cancer Lett. 288, 10\u201316. https:\/\/doi.org\/10.1016\/j.canlet.2009.05.027 (2010).","journal-title":"Cancer Lett."},{"key":"53563_CR21","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.18632\/oncotarget.1738","volume":"5","author":"S Candido","year":"2014","unstructured":"Candido, S. et al. Roles of neutrophil gelatinase-associated lipocalin (NGAL) in human cancer. Oncotarget 5, 1576\u20131594. https:\/\/doi.org\/10.18632\/oncotarget.1738 (2014).","journal-title":"Oncotarget"},{"key":"53563_CR22","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1007\/s11033-011-0828-9","volume":"39","author":"CJ Liao","year":"2012","unstructured":"Liao, C. J., Huang, Y. H., Au, H. K., Wang, L. M. & Chu, S. T. The cancer marker neutrophil gelatinase-associated lipocalin is highly expressed in human endometrial hyperplasia. Mol. Biol. Rep. 39, 1029\u20131036. https:\/\/doi.org\/10.1007\/s11033-011-0828-9 (2012).","journal-title":"Mol. Biol. Rep."},{"key":"53563_CR23","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.cca.2019.07.015","volume":"497","author":"DK Faria","year":"2019","unstructured":"Faria, D. K., Faria, C. S., Doi, D., Acencio, M. M. P. & Antonangelo, L. Hybrid panel of biomarkers can be useful in the diagnosis of pleural and peritoneal effusions. Clin. Chim. Acta. 497, 48\u201353. https:\/\/doi.org\/10.1016\/j.cca.2019.07.015 (2019).","journal-title":"Clin. Chim. Acta"},{"key":"53563_CR24","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s12890-019-0877-8","volume":"19","author":"KA Wu","year":"2019","unstructured":"Wu, K. A. et al. Combined serum biomarkers in the noninvasive diagnosis of complicated parapneumonic effusions and empyema. BMC Pulm Med. 19, 108. https:\/\/doi.org\/10.1186\/s12890-019-0877-8 (2019).","journal-title":"BMC Pulm Med."},{"key":"53563_CR25","doi-asserted-by":"publisher","unstructured":"G\u00fcm\u00fcs, A. et al. A novel biomarker in the diagnosis of parapneumonic effusion: neutrophil gelatinase-associated lipocalin. Multidiscip Respir. Med. 9 https:\/\/doi.org\/10.1186\/2049-6958-9-49 (2014).","DOI":"10.1186\/2049-6958-9-49"},{"key":"53563_CR26","doi-asserted-by":"publisher","first-page":"1960","DOI":"10.1016\/j.rmed.2006.02.025","volume":"100","author":"JM Porcel","year":"2006","unstructured":"Porcel, J. M. et al. Bayesian analysis using continuous likelihood ratios for identifying pleural exudates. Respir. Med. 100, 1960\u20131965. https:\/\/doi.org\/10.1016\/j.rmed.2006.02.025 (2006).","journal-title":"Respir. Med."},{"key":"53563_CR27","doi-asserted-by":"publisher","first-page":"102924","DOI":"10.1016\/j.ebiom.2020.102924","volume":"58","author":"S Wang","year":"2020","unstructured":"Wang, S. et al. Development and validation of a novel scoring system developed from a nomogram to identify malignant pleural effusion. EBioMedicine 58, 102924. https:\/\/doi.org\/10.1016\/j.ebiom.2020.102924 (2020).","journal-title":"EBioMedicine"},{"key":"53563_CR28","doi-asserted-by":"publisher","first-page":"e012799","DOI":"10.1136\/bmjopen-2016-012799","volume":"6","author":"JF Cohen","year":"2016","unstructured":"Cohen, J. F. et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 6, e012799. https:\/\/doi.org\/10.1136\/bmjopen-2016-012799 (2016).","journal-title":"BMJ Open."},{"key":"53563_CR29","doi-asserted-by":"publisher","first-page":"e027287","DOI":"10.1136\/bmjopen-2018-027287","volume":"9","author":"YQ Han","year":"2019","unstructured":"Han, Y. Q. et al. A Study Investigating Markers in PLeural Effusion (SIMPLE): a prospective and double-blind diagnostic study. BMJ Open. 9, e027287. https:\/\/doi.org\/10.1136\/bmjopen-2018-027287 (2019).","journal-title":"BMJ Open."},{"key":"53563_CR30","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.21037\/jtd-23-1731","volume":"16","author":"T Wijayaratne","year":"2024","unstructured":"Wijayaratne, T., Yousuf, A. & Panchal, R. Cardiac related pleural effusions: a narrative review. J. Thorac. disease. 16, 1674\u20131686. https:\/\/doi.org\/10.21037\/jtd-23-1731 (2024).","journal-title":"J. Thorac. disease"},{"key":"53563_CR31","first-page":"4099","volume":"8","author":"J Wang","year":"2015","unstructured":"Wang, J., Zhu, H. H., Xue, J. H., Wu, S. S. & Chen, Z. Effects of storage conditions on the stability of serum CD163, NGAL, HMGB1 and MIP2. Int. J. Clin. Exp. Pathol. 8, 4099\u20134105 (2015).","journal-title":"Int. J. Clin. Exp. Pathol."},{"key":"53563_CR32","doi-asserted-by":"publisher","first-page":"374","DOI":"10.3109\/00365513.2010.486868","volume":"70","author":"KR Pedersen","year":"2010","unstructured":"Pedersen, K. R., Ravn, H. B., Hjortdal, V. E., Norregaard, R. & Povlsen, J. V. Neutrophil gelatinase-associated lipocalin (NGAL): validation of commercially available ELISA. Scand. J. Clin. Lab. Investig. 70, 374\u2013382. https:\/\/doi.org\/10.3109\/00365513.2010.486868 (2010).","journal-title":"Scand. J. Clin. Lab. Investig."},{"key":"53563_CR33","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1053\/j.ajkd.2013.10.010","volume":"63","author":"M van de Vrie","year":"2014","unstructured":"van de Vrie, M., Deegens, J. K., van der Vlag, J. & Hilbrands, L. B. Effect of long-term storage of urine samples on measurement of kidney injury molecule 1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL). Am. J. Kidney Dis. 63, 573\u2013576. https:\/\/doi.org\/10.1053\/j.ajkd.2013.10.010 (2014).","journal-title":"Am. J. Kidney Dis."},{"key":"53563_CR34","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/0895-4356(93)90012-p","volume":"46","author":"DL Simel","year":"1993","unstructured":"Simel, D. L., Samsa, G. P. & Matchar, D. B. Likelihood ratios for continuous test results\u2013making the clinicians\u2019 job easier or harder? J. Clin. Epidemiol. 46, 85\u201393. https:\/\/doi.org\/10.1016\/0895-4356(93)90012-p (1993).","journal-title":"J. Clin. Epidemiol."},{"key":"53563_CR35","doi-asserted-by":"publisher","unstructured":"Romejko, K., Markowska, M. & Niemczyk, S. The Review of Current Knowledge on Neutrophil Gelatinase-Associated Lipocalin (NGAL). Int. J. Mol. Sci. 24 https:\/\/doi.org\/10.3390\/ijms241310470 (2023).","DOI":"10.3390\/ijms241310470"},{"key":"53563_CR36","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1515\/cclm-2024-0542","volume":"63","author":"WQ Zheng","year":"2025","unstructured":"Zheng, W. Q., Porcel, J. M. & Hu, Z. D. Tumor markers determination in malignant pleural effusion: pearls and pitfalls. Clin. Chem. Lab. medicine: CCLM \/ FESCC. 63, 515\u2013520. https:\/\/doi.org\/10.1515\/cclm-2024-0542 (2025).","journal-title":"Clin. Chem. Lab. medicine: CCLM \/ FESCC"},{"key":"53563_CR37","doi-asserted-by":"publisher","unstructured":"Zheng, W. Q., Porcel, J. M., Lee, Y. C. G. & Hu, Z. D. Pleural fluid biochemical analyses: a state-of-the-art review. Crit. Rev. Clin. Lab. Sci. 1\u201318. https:\/\/doi.org\/10.1080\/10408363.2025.2577984 (2025).","DOI":"10.1080\/10408363.2025.2577984"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-53563-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-53563-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-53563-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T22:31:37Z","timestamp":1785105097000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-53563-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["53563"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-53563-8","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]},"assertion":[{"value":"13 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study protocol was reviewed and approved by the Ethics Committee of Inner Mongolia Medical University (Approval Numbers: 2018011). The informed consent was obtained from all participants and\/or their legal guardians.","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"23227"}}