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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
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
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