{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T11:10:21Z","timestamp":1778670621599,"version":"3.51.4"},"reference-count":31,"publisher":"Walter de Gruyter GmbH","issue":"2","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100031555","name":"Fundaci\u00f3n Jos\u00e9 Luis Casta\u00f1o-SEQC","doi-asserted-by":"publisher","award":["Ayudas para Profesionales J\u00f3venes para Tesis Doctoral 2023"],"award-info":[{"award-number":["Ayudas para Profesionales J\u00f3venes para Tesis Doctoral 2023"]}],"id":[{"id":"10.13039\/100031555","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Fundaci\u00f3 Institut d'Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed","award":["23 Convocat\u00f2ria de les Beques Taul\u00ed de Recerca i Innovaci\u00f3"],"award-info":[{"award-number":["23 Convocat\u00f2ria de les Beques Taul\u00ed de Recerca i Innovaci\u00f3"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_almed-2025-0175_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The objectives of this study included assessing the diagnostic performance of HE4 in malignant pleural effusions (MPEs) and identifying the benign etiologies associated with higher HE4 concentrations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_almed-2025-0175_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study involved patients with pleural effusion (PE) treated at Part Taul\u00ed University Hospital. PE and serum samples were collected and analyzed. Diagnosis of MPE was established by the presence of a positive cytology and\/or positive pleural biopsy. HE4 concentrations in LP and serum\u00a0\u2013\u00a0among other parameters\u00a0\u2013\u00a0were measured on an ECLIA-Cobas e801 (Roche Diagnostics) analyzer. Subsequently, pleural fluid to serum HE4 ratio (PF\/serum HE4 ratio) was calculated. Patients were assigned to different groups according to final diagnosis, transudate vs. exudate, MPE etiology and estimated glomerular filtration rate (eGFR). An evaluation was performed of the diagnostic performance of HE4 for\u00a0MPE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_almed-2025-0175_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 253 PF and serum samples were included. In patients with benign pleural effusion (BPE), transudates contained higher levels of HE4, as compared to exudates. The highest PF-HE4 concentrations and ratios were observed in MPEs, especially in patients with non-small cell lung cancer\u00a0+\u00a0ovarian cancer. The cut-off values established showed a sensitivity of 16.7\u202f% (PF-HE4) and\u00a012.1\u202f% (ratio), with a 100\u202f% specificity, respectively. Following cut-off adjustment, higher sensitivity values were observed in patients with an eGFR \u2265 30\u202fmL\/min\/1.73\u202fm\n                      <jats:sup>2<\/jats:sup>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_almed-2025-0175_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Elevated HE4 concentrations may support MPE diagnosis and predict histology. Transudates contain elevated levels of HE4 and lower PF\/serum-HE4 ratios. In the investigation of solid neoplasms, different serum HE4\u00a0cut-off values should be used for patients with PE, heart failure, cirrhosis or renal insufficiency.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/almed-2025-0175","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T18:56:38Z","timestamp":1775760998000},"page":"105-115","source":"Crossref","is-referenced-by-count":0,"title":["Determination of HE4 in pleural fluid and ratio: considerations and diagnostic performance for malignant pleural effusion"],"prefix":"10.1515","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0254-2175","authenticated-orcid":false,"given":"Elisa","family":"Nuez-Zaragoza","sequence":"first","affiliation":[{"name":"Clinical Laboratory Department , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8593-3381","authenticated-orcid":false,"given":"Indira","family":"Bhambi-Blanco","sequence":"additional","affiliation":[{"name":"Clinical Laboratory Department , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1734-1954","authenticated-orcid":false,"given":"Isabel","family":"Aparicio-Calvente","sequence":"additional","affiliation":[{"name":"Clinical Laboratory Department , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2411-7559","authenticated-orcid":false,"given":"M\u00f2nica","family":"Vidal-Pla","sequence":"additional","affiliation":[{"name":"Clinical Laboratory Department , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Rosa","family":"Escoda-Giralt","sequence":"additional","affiliation":[{"name":"Department of Pathology , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joana","family":"Gallardo-Campos","sequence":"additional","affiliation":[{"name":"Department of Pathology , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7742-0239","authenticated-orcid":false,"given":"Joan C.","family":"Ferreres","sequence":"additional","affiliation":[{"name":"Department of Pathology , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0346-5068","authenticated-orcid":false,"given":"Luis","family":"Frisancho","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4963-7072","authenticated-orcid":false,"given":"Laia","family":"Mas-Maresma","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Aguilera-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7540-5285","authenticated-orcid":false,"given":"Sonia","family":"Marco-Continente","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6953-8505","authenticated-orcid":false,"given":"Marina","family":"Sierra-Boada","sequence":"additional","affiliation":[{"name":"Department of Oncology , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1613-9306","authenticated-orcid":false,"given":"Pablo","family":"Andreu-Cobo","sequence":"additional","affiliation":[{"name":"Department of Oncology , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8882-4033","authenticated-orcid":false,"given":"Miquel","family":"Gallego","sequence":"additional","affiliation":[{"name":"Department of Pulmonology , Parc Taul\u00ed University Hospital, Institut d\u2019Investigaci\u00f3 i Innovaci\u00f3 Parc Taul\u00ed (I3PT-CERCA), Universitat Aut\u00f2noma de Barcelona , Sabadell , Barcelona , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7606-5121","authenticated-orcid":false,"given":"Vicente","family":"Aguadero","sequence":"additional","affiliation":[{"name":"Department of Biochemistry , CLILAB, Sant Joan Desp\u00ed-Mois\u00e8s Broggi Hospital , Sant Joan Desp\u00ed , 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