Diagnostic Prediction Model of Tuberculous Pleural Effusion 

Pradipto Utomo1, Telly Kamelia2, Ceva Wicaksono Pitoyo2, Ina Susianti Timan3, C. Martin Rumende2
1 Internal Medicine Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
2 Respirology and Critical Care Division, Internal Medicine Department, Faculty of Medicine, Universitas Indonesia,
Jakarta, Indonesia
3Clinical Pathology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

Abstract

Background: Percentage of TPE reach 20% of total EPTB cases. The diagnosis of TPE is difficult due to pleural biopsy procedure invasiveness and acid fast stain low sensitivity. Adenosine deaminase (ADA) can become reference test with high sensitivity and specificity but availability in primary health care is limited.
Objective: Analyze prediction model in diagnosis of tuberculous pleural effusion.
Methods: This study uses a cross-sectional method. The study was conducted at Cipto mangunkusumo Hospital. Independent variables consist of age, pleuritic chest pain, unilateral pleural effusion, glucose pleural fluid ?70 mg/dL, exudative mononuclear pleural effusion, negative cytology malignancy, ultrasound characteristic and blood neutrophil-lymphocyte ratio. ADA ?35 suggests TPE. The variaables analyzed bivariately, multivariately, ROC curve and Hosmer-Lemeshow.
Results: There were 91 subjects with characteristic of male 41 subjects (45,1%) and female 50 subjects (54,9%). Malignancy was the most frequent comorbid with 52 subjects (57,1%). Factors associated with TPE diagnosis are complex ultrasound characteristic OR 5,655 (CI 95% 1,700-18,812), pleural fluid glucose ?70 mg/dL OR 11,262 (CI 95% 2,931-43,276) and exudative mononuclear dominant pleural effusion OR 8,567 (CI 95% 2,114-34,715). In ROC curve conclude AUC 0,841 with p<0,001 CI 95% (0,762-0,926). The result is a scoring system cut-off value ?2 with probability 92,8%.
Conclusion: Predicted factors of TPE diagnosis are complex ultrasound characteristic, low pleural fluid glucose and exudative mononuclear dominant pleural effusion. The result is scoring system with cut-off value ?2 with probability 92,8%.
Keywords: Tuberculous pleural effusion, ADA, complex ultrasound characteristic, exudative mononuclear dominant pleural fluid, pleural fluid glucose