Luis Corral-Gudino1,2, Alberto García-Zamalloa3, Cristina Prada-González4, Silvia Bielsa5, Duckens Alexis4, Jorge Taboada-Gómez6, Pilar R Dos-Santos-Gallego4, María A Alonso-Fernández4, Jose M Porcel5. 1. Department of Internal Medicine, Servicio de Medicina Interna, Hospital El Bierzo, Calle Médicos sin Fronteras, 7, CP: 24404, Ponferrada, León, Spain. lcorral@saludcastillayleon.es. 2. RETICEF, IBSAL, Salamanca, Spain. lcorral@saludcastillayleon.es. 3. Mycobacterial Infection Study Group (GEIM) from the Spanish Infectious Diseases Society, Department of Internal Medicine, Mendaro Hospital, Mendaro, Gipuzkoa, Spain. 4. Department of Internal Medicine, Servicio de Medicina Interna, Hospital El Bierzo, Calle Médicos sin Fronteras, 7, CP: 24404, Ponferrada, León, Spain. 5. Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Institut for Biomedical Research in Lleida Dr Pifarre Foundation, Lleida, Spain. 6. Preventive Medicine and Western Gipuzkoa Clinical Research Unit, Mendaro Hospital, Mendaro, Gipuzkoa, Spain.
Abstract
BACKGROUND: The frequency of "complicated" pleural effusions (CPE) (i.e., pleural fluid pH ≤ 7.2 and/or glucose ≤60 mg/dL) of tuberculous origin (CTPE) is not well reported. This study aims to quantify their prevalence, and develop a score to differentiate CTPE from complicated parapneumonic effusions (CPPE). METHODS: Retrospective analysis of databases from three Spanish hospitals which included patients with CTPE and CPPE. Forty percent of the study population served to generate a scoring system (COMPLES, COMplicated PLeural Effusion Score) that was further validated in the remaining 60 %. RESULTS: During the study period (1992-2015) 549 patients were diagnosed with tuberculous effusions and 434 parapneumonic effusions, of whom 25 and 64 %, respectively, had CPE. COMPLES was based on the combination of pleural fluid adenosine deaminase (ADA), the percentage of mononuclear cells (MNC %), pH, and age. The cutoff values and assigned scores were: ADA (<46 IU/L [0 points], 46-100 IU/L [4 points], ≥100 IU/L [6 points]), MNC % (<10 % [0 points], 10-50 [3 points], >50 [8 points]), pH (<7.07 [0 points], 7.07-7.20 [3 points], >7.20 [5 points]), and age (≥30 [0 points], <30 years [3 points]). A sum of 12 or more points had 97 % sensitivity, 92 % specificity, likelihood ratio positive 12.3, likelihood ratio negative 0.03, and area under the curve of 0.947 for identifying CTPE versus CPPE in the validation set. CONCLUSIONS: CPE is not an unusual presentation of tuberculosis. A simple new scoring system provides a reliable tool for differentiating between CTPE and CPPE.
BACKGROUND: The frequency of "complicated" pleural effusions (CPE) (i.e., pleural fluid pH ≤ 7.2 and/or glucose ≤60 mg/dL) of tuberculous origin (CTPE) is not well reported. This study aims to quantify their prevalence, and develop a score to differentiate CTPE from complicated parapneumonic effusions (CPPE). METHODS: Retrospective analysis of databases from three Spanish hospitals which included patients with CTPE and CPPE. Forty percent of the study population served to generate a scoring system (COMPLES, COMplicated PLeural Effusion Score) that was further validated in the remaining 60 %. RESULTS: During the study period (1992-2015) 549 patients were diagnosed with tuberculous effusions and 434 parapneumonic effusions, of whom 25 and 64 %, respectively, had CPE. COMPLES was based on the combination of pleural fluid adenosine deaminase (ADA), the percentage of mononuclear cells (MNC %), pH, and age. The cutoff values and assigned scores were: ADA (<46 IU/L [0 points], 46-100 IU/L [4 points], ≥100 IU/L [6 points]), MNC % (<10 % [0 points], 10-50 [3 points], >50 [8 points]), pH (<7.07 [0 points], 7.07-7.20 [3 points], >7.20 [5 points]), and age (≥30 [0 points], <30 years [3 points]). A sum of 12 or more points had 97 % sensitivity, 92 % specificity, likelihood ratio positive 12.3, likelihood ratio negative 0.03, and area under the curve of 0.947 for identifying CTPE versus CPPE in the validation set. CONCLUSIONS: CPE is not an unusual presentation of tuberculosis. A simple new scoring system provides a reliable tool for differentiating between CTPE and CPPE.
Authors: G L Colice; A Curtis; J Deslauriers; J Heffner; R Light; B Littenberg; S Sahn; R A Weinstein; R D Yusen Journal: Chest Date: 2000-10 Impact factor: 9.410
Authors: L Valdés; E San José; J M Alvarez Dobaño; A Golpe; J M Valle; P Penela; F J González Barcala Journal: Eur Respir J Date: 2008-12-01 Impact factor: 16.671