Abstract
Background and Objective: The accurate differential diagnosis of tuberculous pleural effusion (TPE) from other exudative pleural effusions is often challenging. We aimed to validate the accuracy of complement component C1q in pleural fluid (PF) in diagnosing TPE.Methods: The level of C1q protein in the PF from 49 patients with TPE and 61 patients with non-tuberculous pleural effusion (non-TPE) was quantified by enzyme-linked immunosorbent assay, and the diagnostic performance was assessed by receiver operating characteristic (ROC) curves based on the age and gender of the patients.Results: The statistics showed that C1q could accurately diagnose TPE. Regardless of age and gender, with a cutoff of 6,883.9 ng/mL, the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of C1q for discriminating TPE were 0.898 (95% confidence interval: 0.825–0.947), 91.8 (80.4–97.7), 80.3 (68.2–89.4), 78.9 (69.2–86.2), and 92.5 (82.6–96.9), respectively. In subgroup analysis, the greatest diagnostic accuracy was achieved in the younger group (≤ 50 years of age) with an AUC of 0.981 (95% confidence interval: 0.899–0.999) at the cutoff of 6,098.0 ng/mL. The sensitivity, specificity, PLR, NLR, PPV, and NPV of C1q were 95.0 (83.1–99.4), 92.3 (64.0–99.8), 97.4 (85.2–99.6), and 85.7 (60.6–95.9), respectively.Conclusion: Complement component C1q protein was validated by this study to be a promising biomarker for diagnosing TPE with high diagnostic accuracy, especially among younger patients.
Highlights
Tuberculosis (TB) resulted from Mycobacterium tuberculosis (Mtb) infection is known as one of the major causes of death worldwide
Tuberculous pleural effusion (TPE) was diagnosed if Ziehl–Neelsen staining or Mtb culture of pleural fluid (PF) or pleural biopsy specimens were positive, or if a granuloma was present in the pleural biopsy specimens
With a cutoff of 6,883.9 ng/mL, the area under the Curve (AUC), sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), positive predictive value (PPV), and negative predictive value (NPV) of PF C1q to discriminate TPE and non-TPE cases were 0.898 (95% confidence interval: 0.825–0.947; P < 0.001), 91.8%, 80.3%, 4.7, 0.10, 78.9, and 92.5, respectively (Figure 1B and Table 3)
Summary
Tuberculosis (TB) resulted from Mycobacterium tuberculosis (Mtb) infection is known as one of the major causes of death worldwide. Tuberculous pleural effusion (TPE) is the most common extrapulmonary form of TB (Baumann et al, 2007; Peto et al, 2009; Pang et al, 2019; Kang et al, 2020). TPE is clinically common, its differentiation from other types of exudative pleural effusion, such as malignant pleural effusion (MPE), parapneumonic pleural effusion (PPE), and other types of pleural effusion due to autoimmune diseases etc., is often challenging. Compared with the above methods, biomarkers in pleural fluid (PF), such as adenosine deaminase (ADA), are an affordable, simplified, non-invasive, and rapid diagnostic method for TPE (Porcel, 2016; Zhang et al, 2020). The accurate differential diagnosis of tuberculous pleural effusion (TPE) from other exudative pleural effusions is often challenging. We aimed to validate the accuracy of complement component C1q in pleural fluid (PF) in diagnosing TPE
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