Unit of General Epidemiology and Disease Control, Institute of Tropical Medicine, Antwerp, Belgium; Instituto Nacional de Salud, Lima, Peru.
Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Chorrillos, Lima, Peru; Departamento de Medicina, Hospital Nacional Hipolito Unanue, Lima, Peru.
Int J Infect Dis. 2018 Apr;69:103-107. doi: 10.1016/j.ijid.2018.01.026. Epub 2018 Feb 10.
To develop a clinical prediction rule (CPR) for the diagnosis of pleural tuberculosis (PT) in patients with pleural exudates in Peru.
Clinical and laboratory information was collected from patients with exudative pleural effusion attending two reference hospitals in Lima, Peru. Predictive findings associated with PT in a multiple logistic regression model were used to develop the CPR. A definite diagnosis of PT was based on a composite reference standard including bacteriological and/or histological analysis of pleural fluid and pleural biopsy specimens.
A total of 238 patients were included in the analysis, of whom 176 had PT. Age, sex, previous contact with a TB patient, presence of lymphadenopathy, and pleural adenosine deaminase (ADA) levels were found to be independently associated with PT. These predictive findings were used to construct a CPR, for which the area under the receiver operating characteristics curve (AUC) was 0.92. The single best cut-off point was a score of ≥60 points, which had a sensitivity of 88%, specificity of 92%, a positive likelihood ratio of 10.9, and a negative likelihood ratio of 0.13.
The CPR is accurate for the diagnosis of PT and could be useful for treatment initiation while avoiding pleural biopsy. A prospective evaluation is needed before its implementation in different settings.
在秘鲁，为患有胸腔渗出液的患者开发一种用于诊断胸腔结核（PT）的临床预测规则（CPR）。
从利马的两家参考医院就诊的胸腔渗出液患者中收集临床和实验室信息。使用多元逻辑回归模型中与 PT 相关的预测发现来开发 CPR。PT 的明确诊断基于包括胸腔液和胸膜活检标本的细菌学和/或组织学分析的综合参考标准。
共纳入 238 例患者进行分析，其中 176 例患有 PT。年龄、性别、与 TB 患者的既往接触、淋巴结病和胸腔腺苷脱氨酶（ADA）水平被发现与 PT 独立相关。这些预测发现被用于构建 CPR，其受试者工作特征曲线（AUC）下的面积为 0.92。最佳截断值为≥60 分，其灵敏度为 88%，特异性为 92%，阳性似然比为 10.9，阴性似然比为 0.13。
CPR 对 PT 的诊断准确，可在避免胸膜活检的情况下有助于开始治疗。在不同环境中实施之前，需要进行前瞻性评估。
