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Predictive Models for Tuberculous Pleural Effusions in a High Tuberculosis Prevalence Region

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Abstract

Background

Patients with pleural effusions who reside in geographic areas with a high prevalence of tuberculosis frequently have similar clinical manifestations of other diseases. The aim of our study was to develop a simple but accurate clinical score for differential diagnosis of tuberculosis pleural effusion (TPE) from non-TB pleural effusion (NTPE).

Methods

This was an unblinded, prospective study of Turkish patients 18 years of age or older with pleural effusion of indeterminate etiology conducted from June 2003 to June 2005. Unconditional logistic regression models were used to discriminate TPE cases from NTPE cases. Standard errors for the area under the curve (AUC) were calculated using the Mann–Whitney method. Data were statistically significance if two-tailed P < 0.05.

Results

A total of 63.3% (157/248) of the patients had TPE while 36.7% (91/248) of the patients had other etiologies for pleural effusions. We were able to provide a predictive model of TPE that included age <47 years and either pleural fluid adenosine deaminase enzyme (PADA) >35 U/l or pleural serum protein ratio >0.710. However, only the combination of age <47 and PADA >35 U/l was significant (odds ratio [OR]: 7.46; 95% confidence interval [CI]: 3.99–13.96). The generated summary score (range = 0–6) was significantly predictive of TPE (OR: 2.91; 95% CI: 2.18–3.89) and with high AUC (0.79).

Conclusion

We propose an affordable model that includes age <47 years and PADA >35 U/l for timely diagnosis of TPE in geographical regions with a high prevalence of TB.

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Abbreviations

ADA:

Adenosine deaminase enzyme

AUC:

Area under curve

BCG:

Bacillus Calmette-Guérin

CxR:

Chest X-ray

HRCT:

High-resolution chest CT

LDH:

Lactate dehydrogenase enzyme

MTB:

Mycobacterium tuberculosis

NTPE:

Non-TB pleural effusion

P/SADA:

Pleural serum ADA ratios

P/SLDH:

Pleural to serum LDH

PADA:

Pleural fluid ADA

PE:

Pleural effusion

PLDH:

Pleural lactate dehydrogenase enzyme

PPD:

Purified protein derivative

ROC:

Receiver operator curves

TB:

Pulmonary tuberculosis

TPE:

TB pleural effusion

TST:

Tuberculin skin test

WHO:

World Health Organization

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Disclosures

None of the materials in this article has been published elsewhere and has not been submitted simultaneously for publication elsewhere. There was no financial support for this work. The results reported in this article do not constitute official policy from the National Institutes of Health. The authors have no conflicts of interest or an acknowledgment to disclose.

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Authors and Affiliations

  1. Department of Thoracic Medicine, GATA Haydarpaşa Training Hospital, Istanbul, Turkey

    Ersin Demirer & Zafer Kartaloglu

  2. Critical Care Medicine Department, National Institutes of Health, Bethesda, MD, USA

    Andrew C. Miller

  3. Department of Medicine, of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Andrew C. Miller

  4. Department of Thoracic Medicine, Istanbul Medipol University, Istanbul, Turkey

    Erdogan Kunter

  5. Research Center of Excellence, James A. Haley Veteran Hospital, Tampa, FL, USA

    Scott D. Barnett

  6. Division of Pulmonary, Critical Care Medicine and Sleep, University of South Florida, Tampa, FL, USA

    Elamin M. Elamin

  7. Division of Pulmonary, Critical Care and Sleep Medicine Section (111C), James A. Haley Veterans Hospital, 13000 Bruce B. Downs Blvd., Tampa, FL, 33612, USA

    Elamin M. Elamin

Authors
  1. Ersin Demirer
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  2. Andrew C. Miller
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  3. Erdogan Kunter
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  4. Zafer Kartaloglu
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  5. Scott D. Barnett
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  6. Elamin M. Elamin
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Correspondence to Elamin M. Elamin.

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Demirer, E., Miller, A.C., Kunter, E. et al. Predictive Models for Tuberculous Pleural Effusions in a High Tuberculosis Prevalence Region. Lung 190, 239–248 (2012). https://doi.org/10.1007/s00408-011-9342-z

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  • DOI: https://doi.org/10.1007/s00408-011-9342-z

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