Porcel José M, Pardina Marina, Alemán Carmen, Pallisa Esther, Light Richard W, Bielsa Silvia
Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Lleida, Spain.
Institute for Biomedical Research in Lleida Dr Pifarré Foundation, IRBLLEIDA, Lleida, Spain.
Respirology. 2017 Aug;22(6):1199-1204. doi: 10.1111/resp.13040. Epub 2017 Mar 30.
Due to limited data, we aimed to develop and validate a computed tomography (CT)-based scoring system for identifying those parapneumonic effusions (PPEs) requiring drainage.
A retrospective review of all patients with PPE who underwent thoracentesis and a chest CT scan before any attempt to place a tube thoracostomy, if applicable, over an 8-year period was conducted. Eleven chest CT characteristics were compared between 90 patients with complicated PPEs (CPPEs), defined as those which eventually required chest drainage, and 60 with non-complicated effusions (derivation sample). A scoring system was devised with those CT findings identified as independent predictors of CPPE in a logistic regression analysis, and further validated in an independent population of 59 PPE patients.
CT scores predicting CPPE were pleural contrast enhancement (3 points), pleural microbubbles, increased extrapleural fat attenuation and fluid volume ≥400 mL (1 point each). A sum score of ≥4 yielded 84% sensitivity (95% CI: 62-85%), 75% specificity (95% CI: 62-85%), 81% diagnostic accuracy (95% CI: 73-86%), likelihood ratio (LR) positive of 3.4 (95% CI: 2.1-5.4), LR negative of 0.22 (95% CI: 0.13-0.36) and area under the receiver operating characteristic curve (AUC) of 0.829 (95% CI: 0.754-0.904) for labelling CPPE in the derivation set. These results were reproduced in the validation sample. The CT grading scale also exhibited a fair ability to identify patients who needed surgery or would die from the pleural infection (AUC: 0.76, 95% CI: 0.61-0.9).
A novel CT scoring system for adults with PPE may allow clinicians to predict the need for chest tube drainage with good accuracy.
由于数据有限，我们旨在开发并验证一种基于计算机断层扫描（CT）的评分系统，用于识别那些需要引流的类肺炎性胸腔积液（PPE）。
对所有患有PPE且在尝试进行胸腔闭式引流（如适用）之前接受过胸腔穿刺术和胸部CT扫描的患者进行了为期8年的回顾性研究。比较了90例复杂性PPE（CPPE，定义为最终需要胸腔引流的患者）和60例非复杂性胸腔积液患者（推导样本）的11项胸部CT特征。通过逻辑回归分析确定那些CT表现为CPPE的独立预测因素，设计了一个评分系统，并在59例PPE患者的独立人群中进一步验证。
预测CPPE的CT评分标准为胸膜对比增强（3分）、胸膜微气泡、胸膜外脂肪衰减增加和液体量≥400 mL（各1分）。总分≥4分时，推导组中标记CPPE的灵敏度为84%（95%CI：62 - 85%），特异度为75%（95%CI：62 - 85%），诊断准确率为81%（95%CI：73 - 86%），阳性似然比（LR）为3.4（95%CI：2.1 - 5.4），阴性似然比为0.22（95%CI：0.13 - 0.36），受试者工作特征曲线（AUC）下面积为0.829（95%CI：0.754 - 0.904）。这些结果在验证样本中得到了重现。CT分级量表在识别需要手术或会死于胸膜感染的患者方面也表现出一定能力（AUC：0.76，95%CI：0.61 - 0.9）。
一种针对成人PPE的新型CT评分系统可能使临床医生能够较为准确地预测胸腔闭式引流的必要性。
