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Conditional diagnostic accuracy according to inflammation status and age for diagnosing tuberculous effusion

BACKGROUND: Tuberculous effusion varies from lymphocyte-dominant to neutrophilic effusion according to inflammation status. The criteria of adenosine deaminase (ADA) and lymphocyte/neutrophil (L/N) ratio have yet not been evaluated across different disease conditions. METHODS: Patients who conducted...

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Autores principales: Jeon, Da Som, Kim, Sung-Hoon, Lee, Jang Ho, Choi, Chang-Min, Park, Hyung Jun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10589957/
https://www.ncbi.nlm.nih.gov/pubmed/37864205
http://dx.doi.org/10.1186/s12890-023-02700-4
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author Jeon, Da Som
Kim, Sung-Hoon
Lee, Jang Ho
Choi, Chang-Min
Park, Hyung Jun
author_facet Jeon, Da Som
Kim, Sung-Hoon
Lee, Jang Ho
Choi, Chang-Min
Park, Hyung Jun
author_sort Jeon, Da Som
collection PubMed
description BACKGROUND: Tuberculous effusion varies from lymphocyte-dominant to neutrophilic effusion according to inflammation status. The criteria of adenosine deaminase (ADA) and lymphocyte/neutrophil (L/N) ratio have yet not been evaluated across different disease conditions. METHODS: Patients who conducted pleural fluid analysis from 2009 to 2019 at Asan Medical Center were included. Criteria (ADA of 50 and L/N ratio of 0.75) were evaluated by quantile subgroups according to age, C-reactive protein (CRP), white blood cell (WBC), and lactate dehydrogenase (LD) by the Monte Carlo simulation method to diagnose tuberculosis. The model for the ADA and L/N ratio was evaluated by AUROC. RESULTS: Among the 2,918 reviewed cases, 2034 were included with 229 (11.26%) tuberculosis cases. The mean baseline ADA AUROC was 0.88 across all patients. Increased CRP and WBC showed high proportions of neutrophilic tuberculous effusion, with low sensitivity of approximately 45% and 33% in the fifth WBC and CRP groups, respectively. The AUROC of the models decreased with the increase in WBC and CRP groups (ADA model: 0.69 [the top quantile WBC group], 0.74 [the top quantile CRP group]). The AUROC of the models did not show a trend according to the increase in LD and age. CONCLUSION: Inflammatory status affects the diagnostic metrics for tuberculous effusion due to the progression of tuberculous effusion. Clinicians should consider the low accuracy of tuberculous effusion criteria in high-inflammatory conditions when diagnosing tuberculosis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-023-02700-4.
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spelling pubmed-105899572023-10-22 Conditional diagnostic accuracy according to inflammation status and age for diagnosing tuberculous effusion Jeon, Da Som Kim, Sung-Hoon Lee, Jang Ho Choi, Chang-Min Park, Hyung Jun BMC Pulm Med Research BACKGROUND: Tuberculous effusion varies from lymphocyte-dominant to neutrophilic effusion according to inflammation status. The criteria of adenosine deaminase (ADA) and lymphocyte/neutrophil (L/N) ratio have yet not been evaluated across different disease conditions. METHODS: Patients who conducted pleural fluid analysis from 2009 to 2019 at Asan Medical Center were included. Criteria (ADA of 50 and L/N ratio of 0.75) were evaluated by quantile subgroups according to age, C-reactive protein (CRP), white blood cell (WBC), and lactate dehydrogenase (LD) by the Monte Carlo simulation method to diagnose tuberculosis. The model for the ADA and L/N ratio was evaluated by AUROC. RESULTS: Among the 2,918 reviewed cases, 2034 were included with 229 (11.26%) tuberculosis cases. The mean baseline ADA AUROC was 0.88 across all patients. Increased CRP and WBC showed high proportions of neutrophilic tuberculous effusion, with low sensitivity of approximately 45% and 33% in the fifth WBC and CRP groups, respectively. The AUROC of the models decreased with the increase in WBC and CRP groups (ADA model: 0.69 [the top quantile WBC group], 0.74 [the top quantile CRP group]). The AUROC of the models did not show a trend according to the increase in LD and age. CONCLUSION: Inflammatory status affects the diagnostic metrics for tuberculous effusion due to the progression of tuberculous effusion. Clinicians should consider the low accuracy of tuberculous effusion criteria in high-inflammatory conditions when diagnosing tuberculosis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-023-02700-4. BioMed Central 2023-10-20 /pmc/articles/PMC10589957/ /pubmed/37864205 http://dx.doi.org/10.1186/s12890-023-02700-4 Text en © The Author(s) 2023, corrected publication 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Jeon, Da Som
Kim, Sung-Hoon
Lee, Jang Ho
Choi, Chang-Min
Park, Hyung Jun
Conditional diagnostic accuracy according to inflammation status and age for diagnosing tuberculous effusion
title Conditional diagnostic accuracy according to inflammation status and age for diagnosing tuberculous effusion
title_full Conditional diagnostic accuracy according to inflammation status and age for diagnosing tuberculous effusion
title_fullStr Conditional diagnostic accuracy according to inflammation status and age for diagnosing tuberculous effusion
title_full_unstemmed Conditional diagnostic accuracy according to inflammation status and age for diagnosing tuberculous effusion
title_short Conditional diagnostic accuracy according to inflammation status and age for diagnosing tuberculous effusion
title_sort conditional diagnostic accuracy according to inflammation status and age for diagnosing tuberculous effusion
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10589957/
https://www.ncbi.nlm.nih.gov/pubmed/37864205
http://dx.doi.org/10.1186/s12890-023-02700-4
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