title: Development and Validation of the COMPLES Score for Differentiating Between Tuberculous Effusions with Low Pleural pH or Glucose and Complicated Parapneumonic Effusions.
abstract: The frequency of "complicated" pleural effusions (CPE) (i.e., pleural fluid pH ≤ 7.2 and/or glucose ≤60 mg/dL) of tuberculous origin (CTPE) is not well reported. This study aims to quantify their prevalence, and develop a score to differentiate CTPE from complicated parapneumonic effusions (CPPE).
  
  
  
  Retrospective analysis of databases from three Spanish hospitals which included patients with CTPE and CPPE. Forty percent of the study population served to generate a scoring system (COMPLES, COMplicated PLeural Effusion Score) that was further validated in the remaining 60 %.
  
  
  
  During the study period (1992-2015) 549 patients were diagnosed with tuberculous effusions and 434 parapneumonic effusions, of whom 25 and 64 %, respectively, had CPE. COMPLES was based on the combination of pleural fluid adenosine deaminase (ADA), the percentage of mononuclear cells (MNC %), pH, and age. The cutoff values and assigned scores were: ADA (<46 IU/L [0 points], 46-100 IU/L [4 points], ≥100 IU/L [6 points]), MNC % (<10 % [0 points], 10-50 [3 points], >50 [8 points]), pH (<7.07 [0 points], 7.07-7.20 [3 points], >7.20 [5 points]), and age (≥30 [0 points], <30 years [3 points]). A sum of 12 or more points had 97 % sensitivity, 92 % specificity, likelihood ratio positive 12.3, likelihood ratio negative 0.03, and area under the curve of 0.947 for identifying CTPE versus CPPE in the validation set.
  
  
  
  CPE is not an unusual presentation of tuberculosis. A simple new scoring system provides a reliable tool for differentiating between CTPE and CPPE.
authors.affiliation: Department of Internal Medicine, Servicio de Medicina Interna, Hospital El Bierzo, Calle Médicos sin Fronteras, 7, CP: 24404, Ponferrada, León, Spain. lcorral@saludcastillayleon.es.|RETICEF, IBSAL, Salamanca, Spain. lcorral@saludcastillayleon.es.
authors.forename: Luis
authors.identifier: 0000-0003-0151-5420
authors.initials: L
authors.lastname: Corral-Gudino
authors.affiliation: Mycobacterial Infection Study Group (GEIM) from the Spanish Infectious Diseases Society, Department of Internal Medicine, Mendaro Hospital, Mendaro, Gipuzkoa, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: García-Zamalloa
authors.affiliation: Department of Internal Medicine, Servicio de Medicina Interna, Hospital El Bierzo, Calle Médicos sin Fronteras, 7, CP: 24404, Ponferrada, León, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Prada-González
authors.affiliation: Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Institut for Biomedical Research in Lleida Dr Pifarre Foundation, Lleida, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bielsa
authors.affiliation: Department of Internal Medicine, Servicio de Medicina Interna, Hospital El Bierzo, Calle Médicos sin Fronteras, 7, CP: 24404, Ponferrada, León, Spain.
authors.forename: Duckens
authors.initials: D
authors.lastname: Alexis
authors.affiliation: Preventive Medicine and Western Gipuzkoa Clinical Research Unit, Mendaro Hospital, Mendaro, Gipuzkoa, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Taboada-Gómez
authors.affiliation: Department of Internal Medicine, Servicio de Medicina Interna, Hospital El Bierzo, Calle Médicos sin Fronteras, 7, CP: 24404, Ponferrada, León, Spain.
authors.forename: Pilar R
authors.initials: PR
authors.lastname: Dos-Santos-Gallego
authors.affiliation: Department of Internal Medicine, Servicio de Medicina Interna, Hospital El Bierzo, Calle Médicos sin Fronteras, 7, CP: 24404, Ponferrada, León, Spain.
authors.forename: María A
authors.initials: MA
authors.lastname: Alonso-Fernández
authors.affiliation: Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Institut for Biomedical Research in Lleida Dr Pifarre Foundation, Lleida, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Porcel
mesh_terms: D000243:Adenosine Deaminase / Q000378:metabolism; D000328:Adult; D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D001987:Bronchiectasis / Q000150:complications; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007963:Leukocytes, Mononuclear; D008169:Lung Abscess / Q000150:complications; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000175:diagnosis* / Q000378:metabolism* / Q000382:microbiology / Q000473:pathology; D011014:Pneumonia / Q000150:complications; D012372:ROC Curve; D012189:Retrospective Studies; D014396:Tuberculosis, Pleural / Q000150:complications*
chemical_list: D000243:Adenosine Deaminase; D005947:Glucose
keywords: Adenosine deaminase; Diagnosis; Parapneumonic effusion; Pleural effusion; Tuberculosis