Development of a diagnostic nomogram for tuberculous pleural effusion

Area of Science:

• Pulmonology
• Infectious Diseases
• Diagnostic Medicine

Background:

• Tuberculous pleural effusion (TPE) is a common extrapulmonary tuberculosis form.
• Diagnosing TPE is challenging, often confused with malignant or parapneumonic effusions.
• Pleural fluid adenosine deaminase (ADA) has variable accuracy and is affected by other exudative diseases.

Purpose of the Study:

• Develop and validate a diagnostic nomogram for TPE.
• Improve TPE diagnostic accuracy using readily available biomarkers.
• Create a cost-effective diagnostic tool for resource-limited settings.

Main Methods:

• Case-control study of exudative pleural effusion patients.
• Analysis of clinical characteristics, serum, and pleural fluid biomarkers.
• Logistic regression for predictor identification and nomogram creation.
• Model performance assessed via ROC curve, calibration plots, and DCA.

Main Results:

• Seventy-nine patients included: 39 TPE, 40 non-TPE (33 malignant, 7 parapneumonic).
• Independent TPE predictors: Pleural fluid ADA ≥ 40 U/L, serum ADA ≥ 29.2 U/L, pleural fluid protein ≥ 46.5 g/L.
• Nomogram achieved AUC of 0.98, 97% sensitivity, 91% specificity, 94% accuracy.
• Excellent calibration and superior net clinical benefit demonstrated by DCA.

Conclusions:

• The nomogram offers a highly accurate, cost-effective TPE diagnostic tool.
• Routine laboratory biomarkers form the basis of this novel diagnostic approach.
• External validation in diverse populations is needed for broader applicability.