title: Diagnostic accuracy of pleural fluid tumor necrosis factor-α in tuberculous pleurisy: A meta-analysis.
abstract: BACKGROUND
  Pleurisy is a common extra pulmonary complication of tuberculosis, but current methods for diagnosing it are fairly crude. Here we product a meta-analysis for the available evidence on the ability of tumor necrosis factor-α (TNF-α) in pleural fluid to serve as a diagnostic marker of tuberculous pleurisy (TP).
  
  
  METHODS
  We searched the PubMed, EMBASE, and Google Scholar databases systematically for studies measuring sensitivity, specificity and other measures of diagnostic accuracy of pleural fluid TNF-α in the diagnosis of TP were meta-analyzed by Stata, version 12 and meta-disc.
  
  
  RESULTS
  A total of six publications reporting seven case-control studies were identified. Pooled results indicated that pleural fluid TNF-α showed a diagnostic sensitivity of 0.89 (95% confidence interval [95% CI] 0.83-0.93; range, 0.42-1.0) and a diagnostic specificity of 0.82 (95% CI: 0.78-0.86; range, 0.58-0.98). The pooled positive likelihood ratio was 4.78 (95% CI: 3.32-6.89); the negative likelihood ratio, 0.16 (95% CI: 0.1-0.27); the diagnostic odds ratio, 32.43 (95% CI: 14.48-72.6); and the area under the curve was 0.8556 (standard error of mean 0.0559).
  
  
  CONCLUSIONS
  Pleural fluid TNF-α levels shows relatively high sensitivity but insufficient specificity for diagnosing TP. Pleural fluid TNF-α measurement may be useful in combination with clinical manifestations and conventional tests such as microbiological examination or pleural biopsy.
authors.affiliation: West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Zhenzhen
authors.initials: Z
authors.lastname: Li
authors.affiliation: West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Wenzhe
authors.initials: W
authors.lastname: Qin
authors.affiliation: West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.affiliation: West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Wu
authors.affiliation: West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China ; Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Xuerong
authors.initials: X
authors.lastname: Chen
keywords: Diagnosis; meta-analysis; tuberculous pleurisy; tumor necrosis factor-α