TITLE:
Pleural Fluid Alkaline Phosphate Levels to Differentiate between Tuberculosis and Malignant Pleural Effusion a Tertiary Care Experience
AUTHORS:
Syed Abdul Waheed, Afshan Nisar, Amanullah Lail, Ghulamullah Lail, Muhammad Imran, Javid Ali, Mahboob Ali, Kamran Khan, Nadeem Rizvi
KEYWORDS:
Pleural Fluid (PF), Alkaline Phosphatase (ALP), Tuberculosis, Malignant
JOURNAL NAME:
Journal of Tuberculosis Research,
Vol.11 No.2,
June
30,
2023
ABSTRACT: Introduction: Pleural effusion (PF) is a common clinical presentation in several
diseases. Tuberculosis is one of the most frequent causes of exudative pleural
effusions in immunocompetent patients. Tuberculosis is the leading cause of
morbidity and mortality from an infectious disease in developing countries.
Pakistan is ranked fifth in the world in terms of tuberculosis high-burden
countries. Various pleural fluid parameters have been used to identify the
cause of pleural effusion. It has been discovered that tuberculous pleural
effusions had a greater alkaline phosphatase (ALP) concentration than
transudative effusions. This study used pleural fluid alkaline phosphatase
levels to distinguish between tuberculous pleural effusion and malignant
pleural effusion because there is little information from tuberculosis-high
burden nations like Pakistan. Study
Design: A descriptive cross-sectional study conducted at the Jinnah Postgraduate Medical Center in Karachi between
October 2016 and October 2017. Material and Methods: The study comprised
all patients who were admitted to the department of chest medicine at Jinnah
post graduate medical centre (JPMC) of either gender between
the ages of 18 and 70 who had exudative lymphocytic pleural effusions lasting
two weeks or more included in the study. Non
probability consecutive sampling was used to collect data. Patients who
have tonsillitis, pharyngitis, pneumonia, asthma, Chronic obstructive pulmonary
disease (COPD), or a history of hemoptysis, Bleeding disorders like, platelet
function disorder, thrombocytopenia, Liver cirrhosis and Pregnant women were
excluded. Parents’ informed consent was obtained after being informed of the study’s
protocol, hazards, and advantages. Each patient had their level of pleural
fluid alkaline phosphate (PALP) assessed. In order to evaluate the patient’s
pleural effusion, a pre-made questionnaire was used. All the collected data
were entered into the SPSS 20. An independent sample t-test was used to
recognize alkaline phosphate levels association with pleural fluid secondary to
tuberculosis or malignancy. Results: In this Descriptive Cross-Sectional
Study, the total of 156 patients with age Mean ± SD of was 41.96 ± 17.05 years. The majority of patients 110 (70.5%) were
male and 46 (29.5%) were female. Advanced age was associated with raised pleural
fluid alkaline phosphatase. The difference of pleural fluid alkaline phosphate level between
tuberculous v/s malignant group was found to be (38.03 ± 45.97)
v/s (82.77 ± 61.80) respectively with P-value (P = 0.0001). Conclusion: Malignant pleural effusions had elevated PALP when compared
to tuberculous pleural effusions in exudative lymphocytic pleural effusions;
better differences are seen in older ages and shorter disease durations.