Rendimento de variáveis clínicas, radiológicas e laboratoriais para o diagnóstico da tuberculose pleural

Neves, Denise Duprat; Dias, Ricardo Marques; Cunha, Antônio José Lêdo Alves da; Chibante, Antônio Monteiro da Silva

doi:10.1590/s1806-37132004000400005

Cited by 7 publications

(9 citation statements)

References 26 publications

(33 reference statements)

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“…All p values were two-sided, and statistical significance was set at 0.05. The ability of each variable to correctly classify patients as TB or NTB was evaluated using odds ratios and the diagnostic accuracy of each variable was calculated according to standard methods [15] and previous published [16].…”

Section: Methodsmentioning

confidence: 99%

Predictive model for the diagnosis of tuberculous pleural effusion

Neves¹,

Dias²,

Cunha³

2007

Braz J Infect Dis

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This study developed a predictive model to identify pleural tuberculosis. A consecutive cases study of patients investigating the cause of pleural effusion, in an area of high prevalence of tuberculosis (Rio de Janeiro, Brazil). Clinical and laboratory variables were compared among patients with tuberculosis (TB) and without tuberculosis (NTB), individually and using logistic regression. The performance was described as diagnostic accuracy, compared to a gold standard in a masked way. We have studied 104 TB patients, 41 with malignant, 29 transudates, 28 parapneumonic, 13 with miscellaneous diseases. After identification of individual discrimination power aided by clinical, radiological and laboratory variables, the following ones were included in a multivariate analysis: ADA, total leukocytes, percentile of lymphocytes, protein, lactate dehydrogenase, duration of disease, age and gender. A logistic regression model to predict pleural tuberculosis including the five first variables showed the best performance. A receiver operating characteristic curve identified the best cutoff at 0.7, resulting in a sensitivity and specificity of more then 95%. The predictive model improved the specificity of ADA alone, keeping its sensitivity. This model seems helpful when a microbiological or histological diagnosis of pleural tuberculosis could not be established. External validation of these results is necessary before recommendation for routine application.

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Section: Methodsmentioning

confidence: 99%

Predictive model for the diagnosis of tuberculous pleural effusion

Neves¹,

Dias²,

Cunha³

2007

Braz J Infect Dis

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“…En relación a la prueba de ADA como diagnóstica de tuberculosis pleural, diversos autores han encontrado diferentes puntos de corte, que varían desde 30 hasta 100 UI/L (tabla 2) (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) , dependiendo esto del grupo de pacientes que formaron parte del estudio, la población cuya epidemiología del Mycobacterium es distinta y los criterios tomados en cuenta para el diagnóstico definitivo de las diferentes enfermedades que ocasionaron el derraTabla 2. Estudios realizados a lo largo del tiempo sobre el valor de la prueba de ADA y sus principales parámetros.…”

Section: Discussionunclassified

Validez de la prueba de adenosina deaminasa y del recuento diferencial de leucocitos para el diagnóstico de tuberculosis pleural

et al. 2011

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ResumenObjetivo: Determinar la validez de la prueba de adenosina deaminasa (ADA) y el recuento diferencial de leucocitos para el diagnóstico de tuberculosis pleural. Diseño: Estudio retrospectivo de precisión diagnóstica. Institución: Hospital Regional de Huacho, Ministerio de Salud, Huacho, Perú. Material: Historias clínicas de pacientes con prueba de ADA en líquido pleural. Intervenciones: Estudio de historias clínicas de pacientes a quienes se les realizó la prueba de ADA en líquido pleural, desde enero 2005 hasta diciembre 2007. El valor de la prueba de ADA y el recuento diferencial de leucocitos fueron analizados mediante la curva ROC. La sensibilidad (Se), especificidad (Sp), valores predictivos (VPP y VPN) y los cocientes de verosimilitud (CVP y CVN) fueron hallados para cada variable. Principales medidas de resultados: Punto de corte para la prueba de ADA para el diagnóstico de tuberculosis pleural. Resultados: La tuberculosis fue culpable de la mayoría de los derrames pleurales; 47,5 fue el punto de corte hallado para la prueba de ADA, con Se y Sp de 73% y 90%, respectivamente (IC 95%: 0,95; p<0,001). La curva ROC para el recuento diferencial de leucocitos dio un punto de corte de 0,725; con Se y Sp de 60,9 y 64,7, respectivamente (IC 95%: 0,47 -0,79; p=0,129). Conclusiones: El mejor punto de corte discriminatorio para el diagnóstico de tuberculosis pleural fue 47,5 UI/L. Esta prueba sirve más para confirmar el diagnóstico que para descartar la enfermedad. Además, un mayor porcentaje de linfocitos en el recuento diferencial de leucocitos (>72%) incrementaría la sospecha de tuberculosis pleural. Palabras clave: Tuberculosis pleural; adenosindesaminasa; recuento de leucocitos diferencial. AbstractObjective: To determine the validity of both adenosine diaminase (ADA) test and differential cell count for pleural tuberculosis diagnosis. Design: Retrospective study for diagnosis precision. Setting: Huacho Hospital, Ministerio de Salud, Huacho, Peru. Material: Medical records of patients with ADA test in pleural fluid. Interventions: Medical records study of patients with ADA test in pleural effusion performed from January 2005 through December 2007. ADA test values and differential cell counts were analyzed by ROC curve. Sensitivity (Se), specificity (Sp), predictive values (VPP and VPN) and likehood ratios (LRP and LRN) were found for each variable. Main outcome measures: ADA test cut-off point for pleural tuberculosis diagnosis. Results: Tuberculosis was responsible for most cases of pleural effusion; 47,5 UI/L was the cut-off point by ROC curve, with Se and Sp 73% and 90%, respectively (IC 95%: 0,74 -0,95; p<0,001). The ROC curve for differential cell count cut-off point was 0,725, with Se and Sp 60,9 and 64,7, respectively (IC 95%: 0,47 -0,79; p=0,129). Conclusions: The best cut-off point for pleural tuberculosis diagnosis was 47,5 UI/L. This test worked better to confirm the disease rather than ruling it out. Thus, a larger percentage of lymphocytes in the differential cell count (>72%) will increase the...

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“…Their principal data are summarized in Table 1, and the accuracy as a diagnostic test is described in Figure 1. (2,4,21,(26)(27)(28)(29)(30)(31) The sum of the studies comprises a sample of 1674 patients. Of those, 857 (51.2%) had tuberculosis, and 817 (48.8%) had effusion of other etiologies.…”

Section: Discussionmentioning

confidence: 99%

“…(1) In Brazil, tuberculosis is the principal cause of exudative pleural effusion, and the extrapulmonary form is the form most commonly seen in adults. (2)(3)(4) The methods currently considered the gold standards in the diagnosis of tuberculosis in the pleural fluid have many problems: low positivity J Bras Pneumol. 2008;34(4): [217][218][219][220][221][222][223][224] Literature, Scientific Electronic Library Online and Medline databases using the following search string: 'adenosine deaminase' AND 'tuberculosis' AND 'pleural' .…”

Section: Introductionmentioning

confidence: 99%

“…(9)(10)(11) In addition to being a method with low operational cost, the determination of ADA levels is simple and demands little technical training, as well as using affordable reagents, glassware and equipment common to most medium-sized laboratories. (8,12) Despite the good results of the determination of ADA levels in the pleural fluid already described in the literature, (2,(13)(14)(15) it must be borne in mind that ADA levels can be elevated in cases of pleural involvement caused by rheumatoid arthritis, in some types of lymphomas and in most empyemas, as well as in cases of tuberculous effusion. (7,8,(16)(17)(18) The number of publications involving the determination of ADA levels as a diagnostic test for pleural tuberculosis has increased.…”

Section: Introductionmentioning

confidence: 99%

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Avaliação da adenosina desaminase no diagnóstico da tuberculose pleural: uma metanálise brasileira

Morisson

Neves

2008

J. bras. pneumol.

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Objective: To evaluate Brazilian studies by summarizing the accuracy of adenosine deaminase in the diagnosis of the pleural tuberculosis, with the objective of lending support to the movement to make the test part of the routine in the investigation of pleural effusions. Methods: A search for Brazilian studies related to the determination of adenosine deaminase levels in the pleural liquid was carried out. These studies were evaluated and included in this study. The data were analyzed using summary receiver operating characteristic (SROC) curves, which enabled the studies to be collected and evaluated regarding the accuracy of the diagnosis. As for the global values of sensitivity and specificity, the Bayes' theorem was applied to calculate the post-test probabilities in different prevalences of the disease. Results: Twenty-five studies dating from 1987 to 2005 and including enough information to be used in the meta-analysis were identified. After evaluation, nine studies were included, totaling 1674 patients. According to the SROC curve, a sensitivity of 91.8% (95% CI: 89.8-93.6%) and a specificity of 88.4% (95% CI: 86.0-90.5%) were found, with an area of 0.969 below the curve. The overall odds ratio was 112.0 (95% CI: 51.6-243.2). Considering a prevalence of tuberculosis of 50% (considered neutral), the post-test probability was 88.7% for a positive test and 91.5% for a negative test. Conclusion: Despite the differences found among studies, it is possible to conclude that the determination of adenosine deaminase levels has high accuracy in the diagnosis of the pleural tuberculosis and should be used as a routine test in its investigation.Keywords: Pleural effusion; Tuberculosis; Diagnosis; Adenosine deaminase; Meta-analysis. ResumoObjetivo: Avaliar trabalhos brasileiros resumindo a acurácia da adenosina desaminase no diagnóstico da tuberculose pleural, com o intuito de contribuir para a concretização do exame como rotina na investigação dos derrames pleurais. Métodos: Depois de realizada uma busca por trabalhos brasileiros referentes à dosagem da adenosina desaminase no líquido pleural, estes foram avaliados e incluídos no estudo.A análise dos dados foi feita por meio da curva summary receiver operating characteristic (SROC) que possibilitou a reunião dos estudos quanto a acurácia para o diagnóstico. Com os valores globais de sensibilidade e especificidade foi aplicado o teorema de Bayes para calcular as probabilidades pós-teste em diferentes prevalências da doença. Resultados: Entre 1987 e 2005 foram encontrados 25 estudos contendo informações suficientes que poderiam ser utilizadas na metanálise. Após avaliação, foram incluídos nove estudos, totalizando 1.674 pacientes. De acordo com a curva SROC, foi encontrada uma sensibilidade de 91,8% (IC95%: 89,8-93,6%) e uma especificidade de 88,4% (IC95%: 86,0-90,5%), com uma área abaixo da curva de 0,969. O odds ratio global foi de 112,0 (IC95%: 51,6-243,2). Considerando uma prevalência da tuberculose pleural de 50% (considerada neutra), a probabilidade do di...

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Rendimento de variáveis clínicas, radiológicas e laboratoriais para o diagnóstico da tuberculose pleural

Cited by 7 publications

References 26 publications

Predictive model for the diagnosis of tuberculous pleural effusion

Predictive model for the diagnosis of tuberculous pleural effusion

Validez de la prueba de adenosina deaminasa y del recuento diferencial de leucocitos para el diagnóstico de tuberculosis pleural

Avaliação da adenosina desaminase no diagnóstico da tuberculose pleural: uma metanálise brasileira

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