Clinical diagnostic algorithm in defining tuberculous unilateral pleural effusion in high tuberculosis burden areas short of diagnostic tools

Journal of Thoracic Disease

article

Rentao Yu¹  Sheng Hu²  Chao Wang³  Hua Zhang⁴  Zhenliang Xiao²  Lijie Ma² 

[1] Department of Dermatology, the First Affiliated Hospital of Chongqing Medical University;Department of Pulmonary and Critical Care Medicine, The General Hospital of Western Theater Command;Department of Pathology, the General Hospital of Western Theater Command;Section of Scientific Research & Training, the General Hospital of Western Theater Command

关键词: Pleural effusion (PE);    tuberculosis (TB);    empirical treatment;    real-world;    overtreatment;   

DOI  :  10.21037/jtd-21-1532

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: Empirical treatment was introduced when pathological or microbiological results of tuberculosis (TB) were not available. This report was designed to evaluate an algorithm based on empirical treatment in defining tuberculous pleural effusion (TPE) in high burden areas but short of diagnostic tools. Methods: In this retrospective study, a total of 924 eligible patients were enrolled and 203 (22.0%) were primarily diagnosed as TPE by our diagnostic algorithm based on effusion characteristics [adenosine deaminase (ADA) and exudate] and immunoassays [purified protein derivative (PPD), M. tuberculosis antibody (TB-Ab) and interferon-gamma release assay (IGRA)]. All diagnosed cases received World Health Organization (WHO) standard anti-TB treatment and 187 of them had at least one year of follow-up. The final diagnosis and prognosis of these patients were traced and recorded. Results: A total of 177 (94.65%) cases benefited from standard treatment, 5 (2.67%) failed due to early termination or drug resistance, and 5 (2.67%) were finally confirmed as misdiagnosis. Regarding diagnostic efficacy, 72 (30.13%) patients received four TB tests, and the combination of the four tests could increase the diagnosis of TPE. Besides, receiving operating characteristics curve (ROC) analysis revealed that our algorithm was the best method to differentiate TPE from malignant pleural effusion (MPE) with higher sensitivity and specificity than other serum markers. Conclusions: This clinical diagnostic algorithm was an efficient and available method for the diagnosis of TPE. This diagnostic algorithm should be implemented in regions with high TB prevalence but short of diagnostic tools.

【 授权许可】

Unknown