Study On The Establishment And Diagnostic Value Of Scoring System For Distinguishing Malignant Pleural Effusion From Benign Pleural Effusion

Objective:To establish a scoring system for differentiating malignant pleural effusion from benign pleural effusion,and to verify its predictive diagnostic value,so as to better serve the clinic.Methods:A total of 310 patients with pleural effusion admitted to the First Hospital of Shanxi Medical University from January 2019 to December 2020 were collected,and the etiology was determined by thoracoscopic pleural biopsy and pathological examination or combined with clinical manifestations,imaging,etiology and other examinations,and pleural effusion was obtained by pleural puncture.According to the diagnostic criteria,they were divided into malignant pleural effusion group and benign pleural effusion group.Collect the clinical,imaging and laboratory data,converts the indexes according to the scope of the reference category variables,using binary logistic regression analysis on relevant indicators to single factor analysis,calculates the was statistically significant(P<0.05)in index of the receiver-operating characteristic curve(receiver operating characteristic curve,the ROC curve)area under curve(area under the curve AUC),Multivariate analysis was performed on the indicators of AUC>0.6 and a diagnostic scoring system for malignant pleural effusion was established.The predictive diagnostic value of the system was verified by drawing ROC curve.Results:1.310 patients with pleural effusion were enrolled in this study.Among them,138 cases of malignant pleural effusion group,the age distribution of patients did not follow the normal distribution,the median was 67.5 years old,the interquartile interval was 15.5years old;78 cases were male(56.4%)and 60 cases were female(43.6%).There were 98 cases of pleural metastasis from lung cancer(71.04%),16 cases of malignant pleural mesothelioma(11.6%),11 cases of digestive tract tumor(8.0%),9 cases of breast cancer(6.5%),2 cases of hematological system tumor(1.4%),1 case of choriocarcinoma(0.7%),and 1 case of melanoma(0.7%).The age distribution of 172 patients in the benign pleural effusion group was not normal,the median was 68 years old,and the interquartile interval was 22 years old.There were 113 males(65.7%)and 59 females(34.3%).There were 76 cases of pleural effusion near pneumonia(44.2%),36 cases of tuberculous pleural effusion(20.9%),36 cases of heart failure(20.9%),15 cases of hypoproteinemia(8.7%),3 cases of cirrhosis(1.7%),3 cases of nephrotic syndrome(1.7%),2 cases of empyema(1.2%),and 1 case of pulmonary embolism(0.6%).Age of patients in the two groups was analyzed by Mann-Whitney U test,P=0.900>0.05,and the difference was not statistically significant.2.Single factor regression analysis: fever(P = 0.000),smoking index(P =0.000),pleural effusion double side(P = 0.026),serum CEA(P = 0.000),serum levels of SCC(P = 0.012),serum NSE(P = 0.016),serum D-dimer(P = 0.000),serum FDP(P =0.045),the ESR(P = 0.009),serum CRP(P = 0.001),and pleural effusion LDH(P =0.000),hydrothorax ADA(P = 0.000)associated with the occurrence of malignant pleural effusion.3.Area under ROC curve:fever(AUC=0.630),smoking index(AUC=0.604),serum CEA(AUC=0.636),serum D-dimer(AUC=0.628),serum CRP(AUC=0.602),pleural fluid LDH(AUC=0.622),pleural fluid ADA(AUC=0.685),a total of 7 indicators AUC>0.6.4.Multivariate regression analysis:fever(P=0.032),serum CEA(P=0.000),serum D-dimer(P=0.003),serum CRP(P=0.018),pleural effusion LDH(P=0.014)and pleural effusion ADA(P=0.000)were ndependent risk factors for MPE(P<0.05),and were included in Logistic regression model.5.The scoring system in this study consisted of fever(-1),serum CEA(2),serum D-dimer(2),serum CRP(-1),pleural effusion LDH(1),and pleural effusion ADA(-3).6.The sensitivity,specificity,positive predictive value and negative predictive value of the scoring system in this study were 90.4%,70.0%,78.0% and 86.1% for the identification of malignant pleural effusion.Conclusion:1.Serum CEA,serum D-dimer and pleural fluid LDH are risk factors for malignant pleural effusion.Fever,serum CRP and pleural effusion ADA are protective factors of malignant pleural effusion.2.The scoring system in this study has a good diagnostic performance in distinguishing malignant pleural effusion from benign pleural effusion.It is a diagnostic method that is easy to obtain,less invasive,less costly and can be popularized.