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Development and Validation of an Easy-to-Use Scoring System Developed from a Nomogram to Identify Malignant Pleural Effusion

25 Pages Posted: 21 Feb 2020

See all articles by Sufei Wang

Sufei Wang

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

Shan Tian

Wuhan University - Department of Gastroenterology

Yuan Li

Wuhan University - Renmin Hospital

Na Zhan

Wuhan University - Department of Pathology

Yingyun Guo

Wuhan University - Department of Gastroenterology

Yu Liu

Huazhong University of Science and Technology - Tongji Medical College

Juanjuan Xu

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

Yanling Ma

Huazhong University of Science and Technology - NHC Key Laboratory of Pulmonary Diseases

Shujing Zhang

Huazhong University of Science and Technology - NHC Key Laboratory of Pulmonary Diseases

Siwei Song

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

Wei Geng

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

Hui Xia

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

Pei Ma

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

Xuan Wang

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

Tingting Liao

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

Yanran Duan

Huazhong University of Science and Technology - School of Public Health

Yang Jin

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

Weiguo Dong

Wuhan University - Department of Gastroenterology

More...

Abstract

Background: This study aimed to establish and validate an easy-to-use scoring system based on a nomogram for the differential diagnosis of malignant pleural effusion (MPE) and benign pleural effusion (BPE).

Methods: One retrospective cohort (N=1261) was used to develop (70% of participants) and internally validate (30% of participants) the predictive model. The clinical, radiological and laboratory features were collected and subjected to logistic regression analyses. The primary predictive model was displayed as a nomogram and then modified into an easy-to-use scoring system, which was externally validated with an independent prospective cohort (N=172).

Findings: The easy-to-use scoring system was composed of fever (3 points), erythrocyte sedimentation rate (4 points), effusion adenosine deaminase (7 points), serum carcinoembryonic antigen (CEA) (4 points), effusion CEA (10 points) and effusion/serum CEA (8 points). With a cutoff value of 15 points, the area under the curve, specificity and sensitivity for identifying MPE were 0.913, 89.10%, 82.63% in the training set, 0.922, 93.48%, 81.51% in the internal validation set, and 0.912, 87.61%, 81.36% in the external validation set, respectively. Moreover, this scoring system was exclusively applied to distinguish lung cancer with PE from tuberculous pleurisy and showed a favorable diagnostic performance in the training and validation sets.

Interpretation: This easy-to-use scoring system was developed from a retrospective cohort and externally validated in an independent prospective study which was registered on Clinical Trials website based on six easily accessible clinical variables exhibited good diagnostic performance to identify malignant pleural effusion.

Trial Registration: The prospective cohort study performed in Wuhan Union Hospital was registered on the Clinical Trials website (No. NCT03997669).

Funding Statement: This work was supported by the National Natural Science Foundation of China (no. 81572942 for Yang Jin, no. 81700091 for Juanjuan Xu).

Declaration of Interests: All authors have no competing interests to report.

Ethics Approval Statement: The institutional ethics committees of Renmin Hospital of Wuhan University (No.WDRY 2019-K014) and Wuhan Union Hospital (No. 2019-S075) reviewed and approved this study protocol. Moreover, the prospective cohort study performed in Wuhan Union Hospital was registered on the Clinical Trials website (No. NCT03997669).

Keywords: malignant pleural effusion, clinical features, nomogram, diagnostic value, scoring system

Suggested Citation

Wang, Sufei and Tian, Shan and Li, Yuan and Zhan, Na and Guo, Yingyun and Liu, Yu and Xu, Juanjuan and Ma, Yanling and Zhang, Shujing and Song, Siwei and Geng, Wei and Xia, Hui and Ma, Pei and Wang, Xuan and Liao, Tingting and Duan, Yanran and Jin, Yang and Dong, Weiguo, Development and Validation of an Easy-to-Use Scoring System Developed from a Nomogram to Identify Malignant Pleural Effusion (February 12, 2020). Available at SSRN: https://ssrn.com/abstract=3537071 or http://dx.doi.org/10.2139/ssrn.3537071

Sufei Wang

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine ( email )

China

Shan Tian

Wuhan University - Department of Gastroenterology

China

Yuan Li

Wuhan University - Renmin Hospital

Wuhan, Hubei 442000
China

Na Zhan

Wuhan University - Department of Pathology

#238 Jiefang Road
Wuhan
China

Yingyun Guo

Wuhan University - Department of Gastroenterology

China

Yu Liu

Huazhong University of Science and Technology - Tongji Medical College

No.13 Hankong Road 13
Wuhan City, Hubei Province 430030
China

Juanjuan Xu

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

China

Yanling Ma

Huazhong University of Science and Technology - NHC Key Laboratory of Pulmonary Diseases

Wuhan
China

Shujing Zhang

Huazhong University of Science and Technology - NHC Key Laboratory of Pulmonary Diseases

Wuhan
China

Siwei Song

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

China

Wei Geng

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

China

Hui Xia

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

China

Pei Ma

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

China

Xuan Wang

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

China

Tingting Liao

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

China

Yanran Duan

Huazhong University of Science and Technology - School of Public Health

1037 Luoyu Rd
Wuhan
China

Yang Jin

Huazhong University of Science and Technology - Department of Respiratory and Critical Care Medicine

China

Weiguo Dong (Contact Author)

Wuhan University - Department of Gastroenterology ( email )

China