Development and validation a simple scoring system to identify malignant pericardial effusion

Abstract

BackgroundMalignant pericardial effusion (MPE) is a serious complication in patients with advanced malignant tumors, which indicates a poor prognosis. However, its clinical manifestations lack specificity, making it challenging to distinguish MPE from benign pericardial effusion (BPE). The aim of this study was to develop and validate a scoring system based on a nomogram to discriminate MPE from BPE through easy-to-obtain clinical parameters.MethodsIn this study, the patients with pericardial effusion who underwent diagnostic pericardiocentesis in Taizhou Hospital of Zhejiang Province from February 2013 to December 2021 were retrospectively analyzed. The eligible patients were divided into a training group (n = 161) and a validation group (n = 66) according to the admission time. The nomogram model was established using the meaningful indicators screened by the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression. Then, a new scoring system was constructed based on this nomogram model.ResultsThe new scoring system included loss of weight (3 points), no fever (4 points), mediastinal lymph node enlargement (2 points), pleural effusion (6 points), effusion adenosine deaminase (ADA≦18U/L) (5 points), effusion lactate dehydrogenase (LDH>1033U/L) (7 points), and effusion carcinoembryonic antigen (CEA>4.9g/mL) (10 points). With the optimal cut-off value was 16 points, the area under the curve (AUC), specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) for identifying MPE were 0.974, 95.1%, 91.0%, 85.6%, 96.8%, 10.56 and 0.05, respectively, in the training set and 0.950, 83.3%, 95.2%, 90.9%, 90.9%, 17.50, and 0.18, respectively, in the validation set. The scoring system also showed good diagnostic accuracy in differentiating MPE caused by lung cancer from tuberculous pericardial effusion (TPE) and MPE including atypical cell from BPE.ConclusionThe new scoring system based on seven easily available variables has good diagnostic value in distinguishing MPE from BPE.

Pathological diagnoses and adenosine deaminase levels in patients undergoing pericardial window operation for large pericardial effusions

“…Survival in patients with malignant pericardial effusion is usually less than 12 months, and hemodynamic instability and death due to pericardial tamponade develop in 1/3 of malignant patients [10].…”

“…The clinical manifestations of patients with malign pericardial effusion are not specific, and it can be quite difficult to distinguish malignant pericardial effusion from benign pericardial effusion. Though exfoliative cytology and diagnostic pericardial biopsy of pericardial effusion are of decisive importance in the diagnosis of malignant pericardial effusion, the sensitivity of these methods is relatively low [10]. The accuracy of cytological fluid analysis is 67-92% and negative reporting of cytology does not exclude malignancy [10][11][12].…”

“…Though exfoliative cytology and diagnostic pericardial biopsy of pericardial effusion are of decisive importance in the diagnosis of malignant pericardial effusion, the sensitivity of these methods is relatively low [10]. The accuracy of cytological fluid analysis is 67-92% and negative reporting of cytology does not exclude malignancy [10][11][12].…”

“…Because of pericardial fluid sampling is a difficult procedure, there are limited resources and studies on this tissue [10]. In this context, proof can be obtained by using biochemical biomarkers that can give results faster than the pathological examination [13][14][15].…”