The differential diagnostic value of pleural effusion heparin-binding protein in parapneumonic effusion

Objective The aim of this study was to evaluate the value of pleural effusion heparin-binding protein(HBP)in differential diagnosis of parapneumonic effusion. Methods Case-control study. The pleural effusion of 189 patients with pleural effusion admitted to Quzhou People′s Hospital from February to July 2018, including parapneumonic effusion (n=72), tuberculous pleural effusion(n=24), cases of malignant pleural effusion (n=46) and transudative pleural effusion (n=47) were collected. Routine analysis, lactate dehydrogenase(LDH), adenosine deaminase (ADA) and total protein(TP)examination of all pleural effusions were performed. The levels of heparin-binding protein in the patients′ pleural fluid were measured by ELISA. The difference in the overall level of each group was determined by One-way ANOVA or LSD test followed by Kruskal-Wallis H test dependence on the homogeneity of variances. The categorical data was analyzed by chi-square test.Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of heparin-binding protein for parapneumonic effusion. Results The concentration of heparin-binding protein was low in malignant pleural effusion[15.2(8.4, 33.3)ng/ml]and transudative effusion[14.1(6.5, 23.0)ng/ml], but high in parapneumonic effusion[316.1(99.5, 399.8)ng/ml]and tuberculous pleurisy[64.7 (18.6, 96.8) ng/ml]. The heparin-binding protein level in parapneumonic effusion was significantly different from the other three groups (H=120.3, P<0.05). The receiver operating characteristic curve analysis for an optimal discrimination between parapneumonic effusion from non-parapneumonic effusion could be performed at a cut-off point of 64.2 ng/ml with area under the curve of 0.953[sensitivity: 88.9%(64/72), specificity: 89.7%(105/117), positive predictive value: 84.2%(64/76), negative predictive value: 92.9%(105/113)]. Conclusions Heparin-binding proteinin pleural fluid is effective to be used to classify parapneumonic effusion samples. The detection of heparin-binding protein in pleural effusion has good sensitivity and specificity. It could be a biomarker for differential diagnosis of parapneumonic effusion.(Chin J Lab Med, 2018, 41: 853-857) Key words: Hydrothorax; Blood proteins; Carrier protein; Antimicrobial cationic peptides; Pneumonia; Pleural effusion; Diagnosis, differential