{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T08:39:23Z","timestamp":1768639163056,"version":"3.49.0"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2021,4,10]],"date-time":"2021-04-10T00:00:00Z","timestamp":1618012800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Disease Markers"],"published-print":{"date-parts":[[2021,4,10]]},"abstract":"<jats:p>Background. An initial step in the evaluation of patients with pleural effusion syndrome (PES) is to determine whether the pleural fluid is a transudate or an exudate. Objectives. To investigate total adenosine deaminase (ADA) as a biomarker to classify pleural transudates and exudates. Methods. An assay of total ADA in pleural fluids (P-ADA) was observed using a commercial kit in a population-based cohort study. Results. 157 pleural fluid samples were collected from untreated individuals with PES due to several causes. The cause most prevalent in transudate samples (21%, <jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>n<\/a:mi>\n                        <a:mo>=<\/a:mo>\n                        <a:mn>33<\/a:mn>\n                        <a:mo>\/<\/a:mo>\n                        <a:mn>157<\/a:mn>\n                     <\/a:math>\n                  <\/jats:inline-formula>) was congestive heart failure (79%, 26\/33) and that among exudate samples (71%, <jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>n<\/c:mi>\n                        <c:mo>=<\/c:mo>\n                        <c:mn>124<\/c:mn>\n                        <c:mo>\/<\/c:mo>\n                        <c:mn>157<\/c:mn>\n                     <\/c:math>\n                  <\/jats:inline-formula>) was tuberculosis (28.0%, 44\/124). There was no significant difference in the proportion of either sex between the transudate and exudate groups. The median values of P-ADA were significantly different (<jats:inline-formula>\n                     <e:math xmlns:e=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\">\n                        <e:mi>P<\/e:mi>\n                        <e:mo>&lt;<\/e:mo>\n                        <e:mn>0.0001<\/e:mn>\n                     <\/e:math>\n                  <\/jats:inline-formula>) between both total exudates (18.4\u2009U\/L; IQR, 9.85-41.4) and exudates without pleural tuberculosis (11.0\u2009U\/L; IQR, 7.25-19.75) and transudates (6.85; IQR, 2.67-11.26). For exudates, the AUC was 0.820 (95% CI, 0.751-0.877; <jats:inline-formula>\n                     <g:math xmlns:g=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\">\n                        <g:mi>P<\/g:mi>\n                        <g:mo>&lt;<\/g:mo>\n                        <g:mn>0.001<\/g:mn>\n                     <\/g:math>\n                  <\/jats:inline-formula>), with excellent discrimination. The optimum cut-off point in the ROC curve was determined as the level that provided the maximum positive likelihood ratio (PLR; 14.64; 95% CI, 2.11-101.9) and was22.0\u2009U\/L. For transudates, the AUC was 0.8245 (95% CI, 0.7470-0.9020; <jats:inline-formula>\n                     <i:math xmlns:i=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\">\n                        <i:mi>P<\/i:mi>\n                        <i:mo>&lt;<\/i:mo>\n                        <i:mn>0.0001<\/i:mn>\n                     <\/i:math>\n                  <\/jats:inline-formula>). Internal validation of the AUC after 1000 resamples was evaluated with a tolerance minor than 2%. The clinical utility was equal to 92% (95% CI, 0.84 to 0.96, <jats:inline-formula>\n                     <k:math xmlns:k=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M6\">\n                        <k:mi>P<\/k:mi>\n                        <k:mo>&lt;<\/k:mo>\n                        <k:mn>0.05<\/k:mn>\n                     <\/k:math>\n                  <\/jats:inline-formula>).Conclusions. P-ADA is a useful biomarker for distinguishing pleural exudates from transudates.<\/jats:p>","DOI":"10.1155\/2021\/6648535","type":"journal-article","created":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T17:16:24Z","timestamp":1618247784000},"page":"1-7","source":"Crossref","is-referenced-by-count":5,"title":["Diagnostic Accuracy with Total Adenosine Deaminase as a Biomarker for Discriminating Pleural Transudates and Exudates in a Population-Based Cohort Study"],"prefix":"10.1155","volume":"2021","author":[{"given":"Bernardo Henrique Ferraz","family":"Maranh\u00e3o","sequence":"first","affiliation":[{"name":"Department of Specialized Medicine, Federal University of the State of Rio de Janeiro, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0067-1341","authenticated-orcid":true,"given":"Cyro Teixeira","family":"da Silva Junior","sequence":"additional","affiliation":[{"name":"Department of Clinics, School of Medicine, Pleurology Teaching and Research Laboratory from Professor Mazzini Bueno Tuberculosis Research and Assistance Center, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge Luiz","family":"Barillo","sequence":"additional","affiliation":[{"name":"General Hospital Santa Teresa, Petropolis, Rio de Janeiro, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmem Lucia Teixeira","family":"de Castro","sequence":"additional","affiliation":[{"name":"Professor Mazzini Bueno Tuberculosis Research and Assistance Center, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joeber Bernardo Soares","family":"de Souza","sequence":"additional","affiliation":[{"name":"General Hospital Santa Teresa, Petropolis, Rio de Janeiro, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia Siqueira","family":"Silva","sequence":"additional","affiliation":[{"name":"Professor Mazzini Bueno Tuberculosis Research and Assistance Center, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Stirbulov","sequence":"additional","affiliation":[{"name":"Department of Clinics, Faculty of Medical Sciences, Santa Casa de Miseric\u00f3rdia de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.2174\/1874306401105010070"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00026.2003"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2006.02.025"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2010.136978"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-77-4-507"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1590\/s1806-37132010000400012"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2010.02.025"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1159\/000063620"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1378\/chest.110.1.97"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1378\/chest.92.2.296"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1378\/chest.98.1.141"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.5.3291"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1378\/chest.98.3.546"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejheart.2003.11.017"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/2609767"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.2217\/bmm.12.89"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2015.246280"},{"key":"18","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.07.045120"},{"key":"19","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiochem.2010.09.005"},{"key":"20","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181d47604"},{"key":"21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2010.12.012"},{"key":"22","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2016.034"},{"key":"23","doi-asserted-by":"publisher","DOI":"10.1016\/S0001-2998(78)80014-2"},{"key":"24","doi-asserted-by":"publisher","DOI":"10.1177\/0962280216680383"},{"key":"25","doi-asserted-by":"publisher","DOI":"10.1159\/000353863"},{"key":"26","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(99)70346-X"},{"key":"27","doi-asserted-by":"publisher","DOI":"10.1080\/03610918.2018.1521974"},{"key":"28","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2012.182576"},{"key":"29","doi-asserted-by":"publisher","DOI":"10.1080\/00365513.2019.1677938"},{"key":"30","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198005153022003"},{"key":"31","doi-asserted-by":"publisher","DOI":"10.3390\/mi11030291"},{"key":"32","doi-asserted-by":"publisher","DOI":"10.1373\/49.1.7"},{"issue":"6","key":"33","first-page":"7239","article-title":"Combined 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