Development Of Clinical Scoring System For Distinguishing Benign And Malignant Pleural Effusion

Background Pleural effusion(PE)is a common clinical complication in patients with physical trauma or systemic diseases such as cancer,inflammation,infection,etc.Distinguishing malignant pleural effusion(MPE)from benign pleural effusion(BPE)remains to be a challenge in clinical practice.The aim of this study was to develop and validate a novel scoring system based on a nomogram for the differential diagnosis of MPE and BPE and to verify its diagnostic accuracy..Methods In this retrospective analysis,a total of 778 eligible patients were randomly divided into training group(538 cases)and internal validation group(240 cases),respectively.The clinical and laboratory features were collected,univariate and multivariate Logistic regression analysis was used to screen variables and select predictors for the training set.The selected variables were used to developed a nomogram,a scoring system based on nomogram was established,and its diagnostic accuracy was verified in the training set and internal validation set.Area under ROC curve,calibration curve and decision curve analysis(DCA)were used to evaluate the distinguishing ability,calibration degree and clinical practicability of the prediction model.Results Five variables including effusion carcinoembryonic antigen(p CEA),effusion carcinoembryonic antigen/serum carcinoembryonic antigen(p CEA/s CEA),effusion lactate dehydrogenase(s LDH/p ADA),erythrocyte sedimentation rate(ESR)and serum carcinoembryonic antigen(s CEA)were identified as valuable parameters used for developing a nomogram.The nomogram showed a good diagnostic performance in the training set.A novel scoring system was then established based on the nomogram to distinguish MPE from BPE.The scoring system showed good diagnostic performance in the training set [area under the curve(AUC)(95% confidence interval(CI)),0.971(0.953 to 0.990);sensitivity,89.0%,and specificity,94.9%],the internal validation set [AUC(95%CI),0.967(0.939 to 0.996);Sensitivity,90.5%,specificity,94.9%],respectively.and DCA analysis showed that the final nomogram was useful for distinguishing MPE from BPE.Conclusion The study developed and internally validated a novel scoring system based on a nomogram originated from five clinical parameters.The novel scoring system showed a good diagnostic performance in distinguishing MPE from BPE and can be conveniently used in clinical settings.