Diagnostic value of the pepsin concentration in saliva and induced sputum for gastroesophageal reflux-induced chronic cough: a prospective clinical study

Abstract

To determine the diagnostic value of the pepsin concentration in saliva and induced sputum for gastroesophageal reflux-induced chronic cough (GERC).A total of 171 patients with chronic cough were enrolled. The diagnosis and treatment followed the chronic cough diagnosis and treatment protocol. Saliva and induced sputum were collected, and the pepsin concentration was determined using Peptest™. A gastroesophageal reflux diagnostic questionnaire (GerdQ) was completed. The diagnostic value of the pepsin concentration in saliva and induced sputum for GERC was analyzed and compared.The salivary pepsin concentration predicted GERC with an area under the receiver operating characteristic curve (AUC) of 0.845. The optimal cut-off value was 76.10 ng·mL−1, the sensitivity 83.58%, and the specificity 82.69%. The pepsin concentration in the induced sputum supernatant for GREC had an AUC of 0.523. When GerdQ was used for GERC diagnosis, the AUC was 0.670, and the diagnostic value of salivary pepsin was better compared to GerdQ (DeLong's test, p=0.0008). Salivary pepsin had a comparable diagnostic value to GerdQ (AUC=0.779versus0.826; p=0.4199) in acidic GERC. Salivary pepsin had superior diagnostic value compared to GerdQ (AUC=0.830versus0.533; p<0.0001) in non-acidic GERC.A salivary pepsin concentration >76.10 ng·mL−1is of good diagnostic value for GERC, especially in non-acidic GERC. The pepsin concentration in induced sputum has a low diagnostic value.