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. 2022 May 27;23(1):134.
doi: 10.1186/s12931-022-02051-4.

Development and validation of a prediction model for tuberculous pleural effusion: a large cohort study and external validation

Yanqing Liu  1 , Zhigang Liang  2 , Songbo Yuan  3 , Shanshan Wang  1 , Fei Guo  1 , Weidong Peng  4 , Jing Yang  5 , Aihua Wu  6
Affiliations

Development and validation of a prediction model for tuberculous pleural effusion: a large cohort study and external validation

Yanqing Liu et al. Respir Res. .

Abstract

Background: Distinguishing tuberculous pleural effusion (TPE) from non-tuberculosis (TB) benign pleural effusion (BPE) remains to be a challenge in clinical practice. The aim of the present study was to develop and validate a novel nomogram for diagnosing TPE.

Methods: In this retrospective analysis, a total of 909 consecutive patients with TPE and non-TB BPE from Ningbo First Hospital were divided into the training set and the internal validation set at a ratio of 7:3, respectively. The clinical and laboratory features were collected and analyzed by logistic regression analysis. A diagnostic model incorporating selected variables was developed and was externally validated in a cohort of 110 patients from another hospital.

Results: Six variables including age, effusion lymphocyte, effusion adenosine deaminase (ADA), effusion lactatedehy drogenase (LDH), effusion LDH/effusion ADA, and serum white blood cell (WBC) were identified as valuable parameters used for developing a nomogram. The nomogram showed a good diagnostic performance in the training set. A novel scoring system was then established based on the nomogram to distinguish TPE from non-TB BPE. The scoring system showed good diagnostic performance in the training set [area under the curve (AUC) (95% confidence interval (CI)), 0.937 (0.917-0.957); sensitivity, 89.0%, and specificity, 89.5%], the internal validation set [AUC (95%CI), 0.934 (0.902-0.966); sensitivity, 88.7%, and specificity, 90.3%], and the external validation set [(AUC (95%CI), 0.941 (0.891-0.991); sensitivity, 93.6%, and specificity, 87.5%)], respectively.

Conclusions: The study developed and validated a novel scoring system based on a nomogram originated from six clinical parameters. The novel scoring system showed a good diagnostic performance in distinguishing TPE from non-TB BPE and can be conveniently used in clinical settings.

Keywords: Adenosine deaminase; Area under the curve; Nomogram; Scoring system; Tuberculous pleural effusion.

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Conflict of interest statement

The authors declare no conflict of interest to this work.

Figures

Fig. 1
Fig. 1
The flowchart of patient selection. A Ningbo First Hospital set. B The Affiliated People Hospital of Ningbo University set. MPE malignant pleural effusion, PE pleural effusion, BPE benign pleural effusion, TB tuberculosis
Fig. 2
Fig. 2
Development of the diagnostic nomogram. A Diagnostic nomogram for distinguishing TPE from non-TB BPE in the training set. B Calibration curve of the nomogram. C Decision curve analysis of the nomogram
Fig. 3
Fig. 3
Discrimination and calibration of the scoring system for distinguishing TPE from non-TB BPE. A–C ROC curves of the scoring system in the training set, internal validation set, and external validation set. B–D Calibration curves of the scoring system in the training set, internal validation set, and external validation set
See this image and copyright information in PMC

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