Abstract
Background
Pleural effusion (PE) is a common manifestation of tuberculosis and malignant tumors, but it is difficult to distinguish tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE), especially by non-invasive detection indicators. We aimed to find effective detection indexes in blood and PE for differentiating patients with tuberculosis from a malignant tumor.
Methods
815 patients were collected who diagnosed with tuberculosis or cancer at Taihe hospital from 2014 to 2017. 717 patients were found to have PE by thoracoscopy. The clinical characteristics, patients’ blood parameters, and PE indicators information were summarized for analysis.
Results
The patients with MPE had higher percentages to be bloody and negative of Rivalta test in PE than patients with TPE. Then for clinical indicators, comparing specific parameters in blood, we observed 18 indicators were higher in the TPE group than in the MPE group. On contrast, 12 indicators were higher in the MPE group than in the TPE group (p < 0.01). In addition, in PE tests, we found there were 3 parameters higher in TPE and other 4 parameters higher in MPE patients group (p < 0.01). Then for clinical diagnosing practice, ROC and PCA analysis were applied. Top six relevant indicators with AUC value over 0.70 were screened out: pADA (0.90), pHsCRP (0.79), sMONp (0.75), sHsCRP (0.73), sESR (0.71), and sD-dimer (0.70). Moreover, with the Logistic regression model, a specific combination of 3 biomarkers pADA, sMONp, and sHsCRP could enhance distinguishing tuberculosis from malignant tumor patients with PE (AUC=0.944, 95% CI=0.925-0.964). For the top single marker pADA, we further analyzed its diagnostic function in patients with different group and observed it kept the high specificity and sensitivity.
Conclusions
The six indicators of pADA, pHsCRP, sMONp, sHsCRP, sESR and sD-dimer showed significant diagnostic value for clinicians. Further, the combination of pADA, sMONp, and sHsCRP has high accuracy for differential diagnosis for the first time. Mostly interestingly, pADA single marker maintained high specificity and sensitivity in patients with different status, which has great value for the rapid and accurate diagnosis of suspected cases.