Development and validation of novel diagnostic nomogram for tuberculous pleurisy based on TB-IGRA results

OBJECTIVE: To establish the diagnostic nomogram for tuberculous pleurisy (TP) based on TB-interferon-gamma release assays (TB-IGRA), as well as clinical and peripheral blood characteristics. MATERIAL AND METHODS: Patients who underwent TB-IGRA tests during hospitalisation and were finally diagnosed, were retrospectively and continuously enrolled. TP was divided into confirmed TP (cTP) and presumptive TP (pTP), and corresponding diagnostic nomograms were established. RESULTS: A total of 1283 patients were enrolled (median age 49 years, range 14–96; males: 63.1%). The area under the curve (AUC) of TB-IGRA was 0.81 (95%CI 0.77–0.84) for cTP ( n = 272) and 0.74 (95%CI 0.71–0.78) for pTP ( n = 644). The false-positive and negative rates of TB-IGRA among non-TP and cTP were respectively 32.4% and 16.8%. Based on LASSO analysis, we then selected respectively 12 and 10 predictors from clinical and peripheral blood characteristics to establish cTP and pTP nomograms (TB-IGRA was selected). The cTP and pTP nomograms had an AUC of 0.93 (95%CI 0.90–0.95) and 0.92 (95%CI 0.90–0.94) in the training group, and 0.91 (95%CI 0.87–0.96) and 0.93 (95%CI 0.89–0.96) in the validation group, respectively, which were superior to TB-IGRA test alone. CONCLUSION: Novel predictive nomograms with less invasiveness were provided based on TB-IGRA test to assist differential diagnosis of TP and non-TP patients.