Predictive models for tuberculous pleural effusions in a high tuberculosis prevalence region

Area of Science:

• Pulmonology
• Infectious Diseases
• Diagnostic Medicine

Background:

• Pleural effusions present diagnostic challenges, especially in tuberculosis-prevalent regions.
• Differentiating tuberculosis pleural effusion (TPE) from non-TB pleural effusion (NTPE) is crucial for effective treatment.

Purpose of the Study:

• To develop a simple and accurate clinical score for the differential diagnosis of TPE.
• To distinguish TPE from NTPE in patients with indeterminate pleural effusion etiology.

Main Methods:

• Prospective study of 248 Turkish patients (≥18 years) with pleural effusion of indeterminate cause.
• Logistic regression models were employed to identify predictors of TPE.
• A predictive model and summary score were developed and validated.

Main Results:

• Tuberculosis pleural effusion (TPE) was diagnosed in 63.3% of patients.
• A significant predictive model for TPE included age <47 years and pleural fluid adenosine deaminase enzyme (PADA) >35 U/l (OR: 7.46).
• The developed summary score demonstrated significant predictive value for TPE with a high area under the curve (AUC = 0.79).

Conclusions:

• An affordable and accurate clinical model combining age <47 years and PADA >35 U/l is proposed for diagnosing TPE.
• This model facilitates timely diagnosis in geographical areas with a high prevalence of tuberculosis.