Multilevel likelihood ratios for identifying exudative pleural effusions
Multilevel likelihood ratios for identifying exudative pleural effusions
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DOI：
10.1378/chest.121.6.1916
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发表时间：
2002-06-01
期刊：
影响因子：
9.6
通讯作者：
Brown, LK
中科院分区：
文献类型：
--
作者：
Heffner, JE;Sahn, SA;Brown, LK
研究目的：为了确定多层次的似然比胸腔积液的测试，通常用于区分渗出性和漏出性pleural effusions.Design：荟萃分析patient-level data.Patient data：选定的研究包括诊断为渗出性或漏出性胸腔积液的患者进行胸腔穿刺术和实验室分析他们的pleural effusions.Measurements和methods：研究确定通过搜索MEDLINE和相关书目。数据来自7名主要研究者的1，448例患者，或从已发表报告的点图中提取。根据在测试结果值范围内分层的提取数据计算似然比。有足够的数据可用于计算Light标准要素的多水平似然比（胸膜液乳酸脱氢酶[LDH]，胸膜液与血清LDH的比率，和胸膜液与血清蛋白的比率），胸膜液蛋白，胸膜液与血清胆固醇的比率，胸膜液胆固醇，和胸膜液与血清白蛋白的梯度。这些测试提供了最临床相关的范围（0至10）的似然比的水平。结论：多级似然比结合临床医生的估计的预测试概率的渗出性胸腔积液提高诊断准确性之间的渗出性和漏出性胸腔积液的区分。似然比避免使用混淆性术语，如“假性渗出物”，这些术语来自于使用单个截点进行胸腔积液检查。
Study objectives: To determine multilevel likelihood ratios for pleural fluid tests that are commonly used to discriminate between exudative and transudative pleural effusions.Design: Meta-analysis of patient-level data.Patient data: Selected studies included patients with diagnoses of exudative or transudative pleural effusions who underwent thoracentesis and laboratory analysis of their pleural fluid.Measurements and methods: Studies were identified by searching MEDLINE and related bibliographies. Data were obtained for 1,448 patients from seven primary investigators or extracted from dot plots in published reports. Likelihood ratios were calculated from extracted data stratified across ranges of test result values.Results: Sufficient data were available to calculate multilevel likelihood ratios for the elements of Light's criteria (pleural fluid lactate dehydrogenase [LDH], ratio of pleural fluid to serum LDH, and ratio of pleural fluid to serum protein), pleural fluid protein, ratio of pleural fluid to serum cholesterol, pleural fluid cholesterol, and gradient of pleural fluid to serum albumin. Each of these tests provided levels of likelihood ratios through the most clinically relevant range (0 to 10).Conclusion: Multilevel likelihood ratios combined with a clinician's estimation of the pretest probability of an exudative effusion improve the diagnostic accuracy of discriminating between exudative and transudative pleural effusions. Likelihood ratios avoid the use of confusing terms, such as "pseudoexudates," that derive from the use of single cutoff points for pleural fluid tests.