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Especially for the diagnosis of TPE in which microbiological confirmation is delayed or not possible. Pleural adenosine deaminase (ADA) is the marker recommended by current guidelines. However, there may be false positives in complicated parapneumonic exudates, lymphomas, malignant pleural effusion, and rheumatoid arthritis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this study, TPEs are compared with transudates. However, 90% of TPEs are lymphocytic (occasionally neutrophilic) exudates. And LDH, along with proteins, is key in Light's criteria for differentiating exudates from pleural transudates, so its increase would not be a specific marker of tuberculosis, but rather an indicator of exudate. Furthermore, CA125 and CYFRA21-1 may increase in other types of exudates, but not in transudates. Previous studies have shown its usefulness in differentiating malignant from non-malignant pleural effusion, including parapneumonic and tuberculous exudates.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Therefore, when comparing the characteristics of PTD with transudates and not with other types of exudates, it is difficult to determine through these parameters whether the origin of the exudate is actually tuberculous, parapneumonic or malignant.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On the other hand, the authors' conclusions contrast with the results they present, as they attribute the results of the combination of LDH, CA125 and CYFRA21-1 to the combination of LDH, ADA and CYFRA21-1. It is possible that it is a typographical error in the manuscript. If this is not the case, it could change the interpretation of the findings.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To conclude, an extension of the study in 2 directions would be particularly interesting. On the one hand, to compare the combination of these 3 factors with that of the markers commonly used in the diagnosis of TPE (ADA, LDH and proteins),<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and on the other hand, to determine their sensitivity and specificity for the differential diagnosis with other causes of exudate. 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Journal Information
Vol. 159. Issue 4.
Pages e29 (August 2022)
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Vol. 159. Issue 4.
Pages e29 (August 2022)
Letter to the Editor
LDH, CA125, and CYFRA21-1 in tuberculous pleural effusion
LDH, CA125 y CYFRA21-1 en el derrame pleural tuberculoso
Ana Naranjo San Migue
Corresponding author
Miembro de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), de la European Respiratory Society (ERS) y de la Sociedad Madrileña de Neumología y Cirugía Torácica (NEUMOMADRID), Madrid, Spain
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