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Development and Validation of the COMPLES Score for Differentiating Between Tuberculous Effusions with Low Pleural pH or Glucose and Complicated Parapneumonic Effusions

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Abstract

Background

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).

Methods

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 %.

Results

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.

Conclusions

CPE is not an unusual presentation of tuberculosis. A simple new scoring system provides a reliable tool for differentiating between CTPE and CPPE.

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Abbreviations

ADA:

Adenosine deaminase

AUC:

Area under curve

CI:

Confidence interval

COMPLES:

Complicated pleural effusion score

CPE:

Complicated pleural effusion

CPPE:

Complicated parapneumonic pleural effusion

CTPE:

Complicated tuberculous pleural effusion

IFN:

Interferon

LDH:

Lactate dehydrogenase

LR:

Likelihood ratio

MNC %:

Percentage of mononuclear cells

NAAT:

Nucleic acid amplification test

NCTPE:

Noncomplicated tuberculous pleural effusion

ROC:

Receiving operating characteristics

TPE:

Tuberculous pleural effusion

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Acknowledgments

The authors thank Mr. Ramiro González for his assistance with the microbiological database in the Ponferrada cohort.

Authors’ Contributions

L.C-G: Development of the study concept and study design, analysis and interpretation of data, statistical analysis, study selection for systematic review, extract data from studies and metaanalysis, drafting the manuscript, generating figures, and final approval of manuscript. C.P-G, D.A, PR.D-S-G: Acquisition of clinical data (Ponferrada), study selection for systematic review, discussing the content and figures, revising the draft, and final approval of manuscript. J.M.P, S.B: Development of study design, acquisition of clinical data (Lleida), analysis and interpretation of data, discussing the content and figures, revising the draft, and final approval of manuscript. A.G-Z, J.T-G: Development of study design, acquisition of clinical data (Mendaro), analysis and interpretation of data, discussing the content and figures, revising the draft, and final approval of manuscript. MA.A-F: Development of the study concept, discussing the content and figures, revising the draft, and final approval of manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, Servicio de Medicina Interna, Hospital El Bierzo, Calle Médicos sin Fronteras, 7, CP: 24404, Ponferrada, León, Spain

    Luis Corral-Gudino, Cristina Prada-González, Duckens Alexis, Pilar R. Dos-Santos-Gallego & María A. Alonso-Fernández

  2. RETICEF, IBSAL, Salamanca, Spain

    Luis Corral-Gudino

  3. Mycobacterial Infection Study Group (GEIM) from the Spanish Infectious Diseases Society, Department of Internal Medicine, Mendaro Hospital, Mendaro, Gipuzkoa, Spain

    Alberto García-Zamalloa

  4. Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Institut for Biomedical Research in Lleida Dr Pifarre Foundation, Lleida, Spain

    Silvia Bielsa & Jose M. Porcel

  5. Preventive Medicine and Western Gipuzkoa Clinical Research Unit, Mendaro Hospital, Mendaro, Gipuzkoa, Spain

    Jorge Taboada-Gómez

Authors
  1. Luis Corral-Gudino
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  2. Alberto García-Zamalloa
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  3. Cristina Prada-González
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  6. Jorge Taboada-Gómez
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  8. María A. Alonso-Fernández
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  9. Jose M. Porcel
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Correspondence to Luis Corral-Gudino.

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Corral-Gudino, L., García-Zamalloa, A., Prada-González, C. et al. Development and Validation of the COMPLES Score for Differentiating Between Tuberculous Effusions with Low Pleural pH or Glucose and Complicated Parapneumonic Effusions. Lung 194, 847–854 (2016). https://doi.org/10.1007/s00408-016-9923-y

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  • DOI: https://doi.org/10.1007/s00408-016-9923-y

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