Development and validation of a prediction model for tuberculous pleural effusion: a large cohort study and external validation

Abstract

Background Distinguishing tuberculous pleural effusion (TPE) from non-tuberculosis (TB) benign pleural effusion (BPE) remains to be a challenge in clinical practice. The aim of the present study was to develop and validate a novel nomogram for diagnosing TPE. Methods In this retrospective analysis, a total of 909 consecutive patients with TPE and non-TB BPE from Ningbo First Hospital were divided into the training set and the internal validation set at a ratio of 7:3, respectively. The clinical and laboratory features were collected and analyzed by logistic regression analysis. A diagnostic model incorporating selected variables was developed and was externally validated in a cohort of 110 patients from another hospital. Results Six variables including age, effusion lymphocyte, effusion adenosine deaminase (ADA), effusion lactatedehy drogenase (LDH), effusion LDH/effusion ADA, and serum white blood cell (WBC) were identified as valuable parameters used for developing a nomogram. The nomogram showed a good diagnostic performance in the training set. A novel scoring system was then established based on the nomogram to distinguish TPE from non-TB BPE. The scoring system showed good diagnostic performance in the training set [area under the curve (AUC) (95% confidence interval (CI)), 0.937 (0.917–0.957); sensitivity, 89.0%, and specificity, 89.5%], the internal validation set [AUC (95%CI), 0.934 (0.902–0.966); sensitivity, 88.7%, and specificity, 90.3%], and the external validation set [(AUC (95%CI), 0.941 (0.891–0.991); sensitivity, 93.6%, and specificity, 87.5%)], respectively. Conclusions The study developed and validated a novel scoring system based on a nomogram originated from six clinical parameters. The novel scoring system showed a good diagnostic performance in distinguishing TPE from non-TB BPE and can be conveniently used in clinical settings.

Diagnostic scoring systems for tuberculous pleural effusion in patients with lymphocyte-predominant exudative pleural profile: A development study

“…We selected candidate predictors for the model based on their previously proposed association with TPE [ 6 , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] ] and their availability in resource-limited settings. To address the limitations of pleural fluid ADA testing, we aimed to develop two diagnostic prediction models.…”

“…Thus, the application of routinely available clinical information might be more attractive and cost-saving. Several clinical factors, including age, gender, presence of fever, pleural fluid lymphocyte percentage, and pleural fluid lactate dehydrogenase (LDH) levels, have been identified as significant predictors associated with TPE [ 6 , [10] , [11] , [12] , [13] , [14] ] which can potentially help in distinguishing TPE from other conditions, such as malignancy.…”

“…Over the years, several diagnostic prediction models have been developed by combining information from multiple predictors to estimate the absolute probability of TPE for each individual patient [ [11] , [12] , [13] , [14] , [15] ]. The discriminative performance of these models was quite promising, ranging from an area under the receiver operating characteristics curve (AuROC) of 0.94–0.99 [ [12] , [13] , [14] , [15] ].…”

“…Over the years, several diagnostic prediction models have been developed by combining information from multiple predictors to estimate the absolute probability of TPE for each individual patient [ [11] , [12] , [13] , [14] , [15] ]. The discriminative performance of these models was quite promising, ranging from an area under the receiver operating characteristics curve (AuROC) of 0.94–0.99 [ [12] , [13] , [14] , [15] ]. However, some of the studies may be subjected to certain types of bias resulting from the inclusion of patients with transudate pleural effusion and the utilization of predictors incorporated within Light's criteria.…”

Clinical significance of pleural fluid lactate dehydrogenase/adenosine deaminase ratio in the diagnosis of tuberculous pleural effusion

“…LDH is a glycolytic enzyme and an important indicator reflecting the body’s inflammatory response. When tissue damage or pleural effusion occurs secondary to an underlying disease process, LDH in serum and surrounding tissues can enter the pleural effusion, leading to an increase in its level within the pleural effusion [ 16 ]. However, LDH in pleural effusion may become elevated in TPE, PPE, and MPE, especially in patients with PPE, which can be clinically classified into three subtypes based on the severity of the condition [ 17 ], namely uncomplicated PPE (UPPE), complicated PPE (CPPE), and empyema.…”