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Development of a clinical prediction rule for the diagnosis of pleural tuberculosis in Peru

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Abstract
Objectives: To develop a clinical prediction rule (CPR) for the diagnosis of pleural tuberculosis (PT) in patients with pleural exudates in Peru. Methods: Clinical and laboratory information was collected from patients with exudative pleural effusion attending two reference hospitals in Lima, Peru. Predictive findings associated with PT in a multiple logistic regression model were used to develop the CPR. A definite diagnosis of PT was based on a composite reference standard including bacteriological and/or histological analysis of pleural fluid and pleural biopsy specimens. Results: A total of 238 patients were included in the analysis, of whom 176 had PT. Age, sex, previous contact with a TB patient, presence of lymphadenopathy, and pleural adenosine deaminase (ADA) levels were found to be independently associated with PT. These predictive findings were used to construct a CPR, for which the area under the receiver operating characteristics curve (AUC) was 0.92. The single best cut-off point was a score of >= 60 points, which had a sensitivity of 88%, specificity of 92%, a positive likelihood ratio of 10.9, and a negative likelihood ratio of 0.13. Conclusions: The CPR is accurate for the diagnosis of PT and could be useful for treatment initiation while avoiding pleural biopsy. A prospective evaluation is needed before its implementation in different settings. (C) 2018 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
Keywords
Tuberculosis, Clinical prediction rules, Aadenosine deaminase, Pleural effusion, Peru, ADENOSINE-DEAMINASE, EXTRAPULMONARY TUBERCULOSIS, DIFFERENTIAL-DIAGNOSIS, EFFUSION, METAANALYSIS, SECONDARY, ACCURACY, CANCER, NEEDLE, BIOPSY

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Chicago
Solari, Lely, Alonso Soto, and Patrick Van Der Stuyft. 2018. “Development of a Clinical Prediction Rule for the Diagnosis of Pleural Tuberculosis in Peru.” International Journal of Infectious Diseases 69: 103–107.
APA
Solari, L., Soto, A., & Van Der Stuyft, P. (2018). Development of a clinical prediction rule for the diagnosis of pleural tuberculosis in Peru. INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES, 69, 103–107.
Vancouver
1.
Solari L, Soto A, Van Der Stuyft P. Development of a clinical prediction rule for the diagnosis of pleural tuberculosis in Peru. INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES. 2018;69:103–7.
MLA
Solari, Lely, Alonso Soto, and Patrick Van Der Stuyft. “Development of a Clinical Prediction Rule for the Diagnosis of Pleural Tuberculosis in Peru.” INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES 69 (2018): 103–107. Print.
@article{8557431,
  abstract     = {Objectives: To develop a clinical prediction rule (CPR) for the diagnosis of pleural tuberculosis (PT) in patients with pleural exudates in Peru. 
Methods: Clinical and laboratory information was collected from patients with exudative pleural effusion attending two reference hospitals in Lima, Peru. Predictive findings associated with PT in a multiple logistic regression model were used to develop the CPR. A definite diagnosis of PT was based on a composite reference standard including bacteriological and/or histological analysis of pleural fluid and pleural biopsy specimens. 
Results: A total of 238 patients were included in the analysis, of whom 176 had PT. Age, sex, previous contact with a TB patient, presence of lymphadenopathy, and pleural adenosine deaminase (ADA) levels were found to be independently associated with PT. These predictive findings were used to construct a CPR, for which the area under the receiver operating characteristics curve (AUC) was 0.92. The single best cut-off point was a score of {\textrangle}= 60 points, which had a sensitivity of 88\%, specificity of 92\%, a positive likelihood ratio of 10.9, and a negative likelihood ratio of 0.13. 
Conclusions: The CPR is accurate for the diagnosis of PT and could be useful for treatment initiation while avoiding pleural biopsy. A prospective evaluation is needed before its implementation in different settings. (C) 2018 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.},
  author       = {Solari, Lely and Soto, Alonso and Van Der Stuyft, Patrick},
  issn         = {1201-9712},
  journal      = {INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES},
  language     = {eng},
  pages        = {103--107},
  title        = {Development of a clinical prediction rule for the diagnosis of pleural tuberculosis in Peru},
  url          = {http://dx.doi.org/10.1016/j.ijid.2018.01.026},
  volume       = {69},
  year         = {2018},
}

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