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Differentiating tuberculous pleuritis from other exudative lymphocytic pleural effusions.
Pichaya Petborom1, Bothamai Dechates2, Panunat Muangnoi2
1HRH Princess Maha Chakri Sirindhorn Medical Center, Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand. pichaya@g.swu.ac.th.
Annals of Palliative Medicine
|September 14, 2020
Summary
This study developed a new scoring system using clinical and pleural fluid data to help diagnose tuberculous pleuritis (TBP). The scoring system aids in differentiating TBP from other effusions when adenosine deaminase (ADA) levels are difficult to determine.
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Pulmonology
Background:
- Clinical and pleural fluid data aid in differentiating tuberculous pleuritis (TBP) from non-TBP effusions.
- Reliable adenosine deaminase (ADA) determination is challenging in certain regions like Thailand.
- A need exists for improved diagnostic scoring systems for TBP.
Purpose of the Study:
- To develop a novel scoring system utilizing clinical and pleural fluid parameters for TBP diagnosis.
- To overcome limitations in obtaining reliable ADA measurements for TBP diagnosis.
- To enhance differential diagnosis accuracy between TBP and non-TBP effusions.
Main Methods:
- A retrospective study involving 15 TBP and 41 non-TBP patients.
- Collection of clinical and pleural fluid data from January 2011 to December 2014.
- Calculation of diagnostic sensitivity, specificity, and predictive values for developed scoring models.
Main Results:
- Scoring models incorporating ADA, age, temperature, red blood cell (RBC) count, cancer history, pleural protein, and LDH ratio showed diagnostic utility.
- Specific thresholds in scoring models I and II demonstrated varying AUC, sensitivity, and specificity.
- Factors like high pleural fluid ADA, low RBC count, and no prior cancer history were significant indicators for probable TBP.
Conclusions:
- The developed scoring systems (model 1 and model 2) show promise in categorizing patients with probable TBP.
- These scoring systems can aid clinical decision-making, especially when ADA levels are uncertain.
- Integration of clinical and pleural fluid parameters offers a viable approach for TBP diagnosis.
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