title: Predicting malignant and tuberculous pleural effusions through demographics and pleural fluid analysis of patients.
abstract: BACKGROUND
  The differential diagnosis of malignant and tuberculous pleural effusion is frequently difficult.
  
  
  OBJECTIVE
  The aim of our study is to determine the discrimination value of demographic parameters and different biological markers in pleural fluid.
  
  
  METHODS
  In pleural fluid obtained from 106 patients with tuberculous, 250 with malignant and 218 with miscellaneous pleural effusion, clinical and analytical parameters were analysed, applying polytomous regression analysis and the receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  The three groups could be differentiated using the measured markers. Age, tumour necrosing factor-alpha, lactate dehydrogenase (LDH), adenosine deaminase (ADA), C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were significant predictors for discriminating tuberculous from malignant pleural effusions; nucleated cells, lymphocytes, cholesterol, LDH, ADA, CRP, CEA and CA15.3 distinguish between malignant and miscellaneous pleural effusions. The ROC areas (95% confidence interval) were, 0.973 (0.953, 0.992) for tuberculous, 0.922 (0.900, 0.943) for miscellaneous, and 0.927 (0.907, 0.948) for malignant pleural effusion. The polytomous model correctly classified a significantly high proportion of patients with tuberculosis (85.8%) and cancer (81.6%). The incorrect classification rate was 17.8%, which increased to 19.5% in the correction using bootstrap.
  
  
  CONCLUSIONS
  The results obtained to estimate the probability of tuberculous and malignant pleural effusion confirm that this model achieves a high diagnostic accuracy. This model should be applied to determine which patients with a pleural effusion of unknown origin would not benefit from further invasive procedures.
authors: Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain.
authors: Luis
authors: L
authors: Valdés
authors: Esther
authors: E
authors: San-José
authors: Lucía
authors: L
authors: Ferreiro
authors: Antonio
authors: A
authors: Golpe
authors: Francisco-Javier
authors: FJ
authors: González-Barcala
authors: María E
authors: ME
authors: Toubes
authors: María X
authors: MX
authors: Rodríguez-Álvarez
authors: José M
authors: JM
authors: Álvarez-Dobaño
authors: Nuria
authors: N
authors: Rodríguez-Núñez
authors: Carlos
authors: C
authors: Rábade
authors: Francisco
authors: F
authors: Gude
mesh_terms: D000243:Adenosine Deaminase / Q000378:metabolism; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism; D012372:ROC Curve; D012737:Sex Factors; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis* / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002272:Carcinoembryonic Antigen; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase; D000243:Adenosine Deaminase
keywords: differential diagnosis; malignant pleural exudates; pleural effusion; tuberculous pleural exudates