Routine Laboratory Tests can Predict In-hospital Mortality in Acute Exacerbations of COPD.
Lung. 2011 May 10;
Authors: Asiimwe AC, Brims FJ, Andrews NP, Prytherch DR, Higgins BR, Kilburn SA, Chauhan AJ
Chronic obstruct…

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Guidelines versus clinical practice in antimicrobial therapy for COPD.

Lung. 2010 Apr;188(2):173-8

Authors: Farkas JD, Manning HL

Limited information is available about current practice patterns involving the use of antibiotics in the inpatient management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We sought to characterize current patterns of antibiotic use and to compare them to evidence-based guidelines. This study is a retrospective case series of patients at a regional tertiary care medical center. Charts were reviewed to identify patients admitted between January 2006 and 2008 with an initial diagnosis of AECOPD who had no evidence of another infectious process and who were not immunocompromised. Relevant data extracted from charts included initial clinical presentation, antibiotic administration, microbiological studies, and hospital course. One hundred sixteen admissions meeting inclusion criteria were identified. There was no statistically significant relationship between the presence of an established indication for antibiotic administration and the use of antibiotics, with roughly 75% of patients in all groups receiving therapy. A significant fraction of patients received combination therapy that was more appropriate for the management of pneumonia than for AECOPD. There were significant deviations between practice patterns and guidelines regarding the use and selection of antibiotics. Some of these may reflect areas of uncertainty in the primary literature and varying sets of guidelines.

PMID: 20066545 [PubMed - indexed for MEDLINE]

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Tuberculous pleural effusion.

Lung. 2009 Sep-Oct;187(5):263-70

Authors: Porcel JM

Tuberculous pleural effusion is one of the most common forms of extrapulmonary tuberculosis (TB). The immediate cause of the effusion is a delayed hypersensitivity response to mycobacterial antigens in the pleural space. For this reason microbiological analyses are often negative and limited by the lengthy delay in obtaining results. In areas with high TB prevalence, pleural fluid adenosine deaminase (ADA) levels greater than 40 U/l argue strongly for TB; in contrast, low levels of pleural ADA have high negative predictive value in low-prevalence countries. The specificity of this enzyme increases if only lymphocytic exudates are considered. The shortcoming of the ADA test is its inability to provide culture and drug sensitivity information, which is paramount in countries with a high degree of resistance to anti-TB drugs. Sputum induction (in addition to pleural fluid) for acid-fast bacilli and culture is a recommended procedure in all patients with TB pleurisy. The microscopic-observation drug-susceptibility assay performed on pleural fluid or pleural tissue increases by two to three times the detection of TB over conventional cultures, and it allows for the identification of multidrug-resistant TB. A reasonable management strategy for pleural TB would be to initiate a four-drug regimen and perform a therapeutic thoracentesis in patients with large, symptomatic effusions.

PMID: 19672657 [PubMed - indexed for MEDLINE]

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Increased pleural fluid adenosine deaminase levels in patients with malignant pleural effusions: a potential predictor of talc pleurodesis outcome.

Lung. 2007 Dec;185(6):349-54

Authors: Yildirim H, Metintas M, Ak G, Erginel S, Alatas F, Kurt E, Metintas S, Ucgun I

Chemical pleurodesis using various sclerosing agents is accepted palliative therapy for patients with recurrent, symptomatic, malignant pleural effusions (MPE). However, the utility of various clinical and biochemical parameters in predicting pleurodesis outcome is still controversial. The objective of this study was to investigate the relationship between pleural fluid adenosine deaminase (Pf-ADA) levels and talc pleurodesis outcomes, and to compare Pf-ADA levels to various other biochemical variables with respect to predicting talc pleurodesis outcome in patients with MPE. In this prospective trial, 60 consecutive patients with MPE were enrolled; 35 had malignant mesothelioma (MM) and 25 had metastatic pleural carcinoma (MPC). A complete response was achieved in 49 of 60 MPE patients (81.7%). The Pf-ADA, pH, and albumin levels in patients with successful pleurodesis were significantly higher than in those with unsuccessful pleurodesis (p values < 0.001, 0.036, 0.027, respectively). ROC curve analysis revealed that optimal differentiation between successful and unsuccessful pleurodesis could be achieved with cutoff points of 17.5 U/L for Pf-ADA (area under the curve = 0.873; sensitivity = 77.6%; specificity = 90.9%); >2.5 g/dl for albumin (area under the curve = 0.715; sensitivity = 85.4%; specificity = 54.5%); and >7.26 for pleural fluid pH (area under the curve = 0.703; sensitivity = 83.7%; specificity = 54.5%). In analysis of the subgroup, Pf-ADA were found to be a good marker for discrimination between successful and unsuccessful pleurodesis in patients with MM (p < 0.001) but not in the MPC group (p = 0.068). These results indicate that Pf-ADA levels could be considered predictors of the outcome of pleurodesis, especially in patient with MM. Furthermore, the present study also demonstrated that Pf-ADA level is a superior test to predict the outcome of pleurodesis compared to pleural fluid pH and albumin level.

PMID: 17952507 [PubMed - indexed for MEDLINE]

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