Performance of clinical prediction rules for diagnosis of pleural tuberculosis in a high-incidence setting

Lely Solari, Alonso Soto, Patrick Van der Stuyft

    Research output: Contribution to journalA1: Web of Science-article

    Abstract

    OBJECTIVES Diagnosis of pleural tuberculosis (PT) is still a challenge, particularly in resource-constrained settings. Alternative diagnostic tools are needed. We aimed at evaluating the utility of Clinical Prediction Rules (CPRs) for diagnosis of pleural tuberculosis in Peru.

    METHODS We identified CPRs for diagnosis of PT through a structured literature search. CPRs using high-complexity tests, as defined by the FDA, were excluded. We applied the identified CPRs to patients with pleural exudates attending two third-level hospitals in Lima, Peru, a setting with high incidence of tuberculosis. Besides pleural fluid analysis, patients underwent closed pleural biopsy for reaching a final diagnosis through combining microbiological and histopathological criteria. We evaluated the performance of the CPRs against this composite reference standard using classic indicators of diagnostic test validity.

    RESULTS We found 15 eligible CPRs, of which 12 could be validated. Most included ADA, age, lymphocyte proportion and protein in pleural fluid as predictive findings. A total of 259 patients were included for their validation, of which 176 (67%) had PT and 50 (19%) malignant pleural effusion. The overall accuracy of the CPRs varied from 41% to 86%. Two had a positive likelihood ratio (LR) above 10, but none a negative LR below 0.1. ADA alone at a cut-off of >= 40 IU attained 87% diagnostic accuracy and had a positive LR of 6.6 and a negative LR of 0.2.

    CONCLUSION Many CPRs for PT are available. In addition to ADA alone, none of them contributes significantly to diagnosis of PT.

    Original languageEnglish
    JournalTropical Medicine and International Health
    Volume22
    Issue number10
    Pages (from-to)1283-1292
    Number of pages10
    ISSN1360-2276
    DOIs
    Publication statusPublished - 2017

    Keywords

    • score
    • adenosine deaminase activity
    • pleural tuberculosis
    • Mycobacterium tuberculosis
    • ADENOSINE-DEAMINASE
    • ACTIVATION PRODUCTS
    • INTERFERON-GAMMA
    • MTB/RIF ASSAY
    • EFFUSIONS
    • METAANALYSIS
    • FLUID
    • THORACOSCOPY
    • ACCURACY
    • DISEASE

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