Pleural fluid matrix metalloproteinase-9 levels and cancer ratio as diagnostic tools for malignant pleural effusion
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Abstract
Introduction. Malignant pleural effusion (PE) poses significant diagnostic and therapeutic challenges due to its diverse etiologies and variable clinical presentations. Accurate differentiation between malignant and non-malignant effusions is crucial for guiding appropriate treatment decisions and improving patient outcomes. Among the biomarkers studied for this purpose, matrix metalloproteinase-9 (MMP-9) in pleural fluid and the cancer ratio (CR) have shown promise in recent research.
Material and methods. This study used a non-randomized cross-sectional observational design, carried out at Saiful Anwar Hospital (January–June 2023), to determine the levels of MMP-9 and CR in pleural fluid in patients with malignant and non-malignant PE and to compare these levels between the two groups.
Results. MMP-9 was higher in malignant PE compared to non-malignant (238.12 vs. 192.27, p < 0.05). CR in malignant PE was higher than in non-malignant PE (40.71 vs. 22.73, p < 0.05). AUC values for MMP-9 and CR were 0.543 (p = 0.025) and 0.788 (p = 0.000), respectively. The sensitivity and specificity of MMP-9 (cut off 112.5) were 57.6% and 63.6%, respectively, while CR (cut off 21.337) were 72.7% and 74.5%, respectively. A combination of MMP-9 > 122.5 and CR > 21.337 provided sensitivity of 45.45%, specificity of 87.27%, and diagnostic accuracy of 71.59% and turned out to be the diagnostic threshold value for the malignant group (p = 0.001)
Conclusions. CR has higher sensitivity and accuracy compared to other biomarkers. The combination of Pleural Fluid MMP-9 and CR shows good specificity.
Keywords: malignant pleural effusionmatrix metalloproteinase-9cancer ratio
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