Authors Name and Affiliations
Title page
Title: Development and validation of the COMPLES score for differentiating between tuberculous effusions with low pleural pH or glucose and complicated parapneumonic effusions
Authors’ name and affiliations:
Luis Corral-Gudino1,2; Alberto García-Zamalloa3; Cristina Prada-González1; Silvia Bielsa4;Duckens Alexis1; Jorge Taboada-Gómez5; Pilar R.Dos-Santos-Gallego1; María A.Alonso-Fernández1; Jose M. Porcel4.
1 Department of Internal Medicine. Hospital El Bierzo. Ponferrada. León. Spain.
2 RETICEF. IBSAL
3Mycobacterial Infection Study Group (GEIM) from the Spanish Infectious Diseases Society, Department of Internal Medicine, Mendaro Hospital, Mendaro, Gipuzkoa,Spain
4Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica de Lleida, Lleida, Spain
5 Preventive Medicine and Western Gipuzkoa Clinical Research Unit, Mendaro Hospital, Mendaro, Gipuzkoa, Spain
Authors’ email addresses:
Corral-Gudino / Luis /García-Zamalloa / Alberto /
Prada-González / Cristina /
Bielsa / Silvia /
Alexis / Duckens /
Taboada-Gómez / Jorge /
Dos-Santos-Gallego / Pilar R. /
Alonso-Fernández / María A. /
Porcel / José M. /
Corresponding author:
Luis Corral-Gudino, Servicio de Medicina Interna. Hospital El Bierzo. Calle Médicos sin Fronteras, 7, CP: 24404. Ponferrada, León. Spain. Phone: +34 987 455 200. Fax: +34 987 455 300. Email:
Funding sources supporting publication of study: None.
Disclosure statement: The authors have declared no conflicts of interest.
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Supplementary Appendix
This appendix has been provided by the authors to give readers additional information about their work.
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Table A. Tuberculosis pleural effusion diagnosis
Lleida / Mendaro / PonferradaTPE (n) / 292 / 183 / 74
Confirmed tuberculosis / 95 (32.5%) / 68 (37.1%) / 24 (32.4%)
Pleural fluid acid-fast smear
Pleural fluid culture
NCTPE
CTPE
Sputum culture
Pleural biopsy
NAAT pleural fluid
Bronchoalveolar lavage
Lymph node biopsy
Skin biopsy / 0
41 (14.0%)
22/221 (10.0%)
19/71 (26.8%)
32 (11.0%)
15 (5.1%)
2 (0.7%)
2 (0.7%)
2 (0.7%)
1 (0.3%) / 0
42 (22.9%)
37/141(26%)
12/36 (26%)
4 (2.2%)
19 (10.3%)
-
3 (1.6%)
-
- / 1 (1.4%)
18 (24.3%)
12/50 (24.0%)
6/24 (25.0%)
7 (9.5%)
4 (5.4%)
1 (1.4%)
-
-
-
Probable tuberculosis / 197 (67.5%) / 115(62.8%) / 50 (67.6%)
CTPE: complicated tuberculosis pleural effusion,NAAT: nucleic acid amplification tests, NCTPE: non-complicated tuberculosis pleural effusion, TPE: tuberculosis pleural effusion.
Table B. Results of pleural fluid cultures in complicated parapneumonic effusions.
Lleida / Mendaro / PonferradaCPPE (n) / 213 / 62 / 39
Pleural fluid positive culture / 66 (31.0%) / 17 (27.4%) / 16 (41.0%)
Gram positive / 51 (23.9%) / 13 (21%) / 13 (33.3%)
Streptococcus “viridans”
Streptococcus pneumoniae
Staphylococcus aureus
Staphylococcus epidermidis
Corynebacterium
Streptococcus pyogenes
Streptococcus species
Staphylococcus species
Micrococcus luteus
Enterococcus faecalis / 16 (7.5%)
13 (6.1%)
11 (5.2%)
5 (2.3%)
2 (0.9%)
1 (0.5%)
1 (0.5%)
1 (0.5%)
1 (0.5%)
1 (0.5%) / 7 (11.2%)
4 (6.4%)
2 (3.2%)
-
-
-
-
-
-
- / 4 (10.3%)
-
6 (15.4%)
2 (5.1%)
1 (2.6%)
-
-
-
-
-
Gram negative / 12 (5.6%) / 4 (6.4%) / 3 (7.7%)
Escherichia coli
Haemophilus influenza
Klebsiella pneumoniae
Salmonella enterica
Pseudomonas
Campylobacter jejini
Stenotrophomonas maltophilia
Gram – bacillus / 5 (2.3%)
2 (0.9%)
-
1 (0.5%)
1 (0.5%)
1 (0.5%)
-
1 (0.5%) / 1 (1.6%)
1 (1.6%)
-
-
-
-
1 (1.6%)
- / -
-
2 (5.1%)
-
1 (2.6%)
-
-
-
Anaerobic
Proteus mirabilis
Capnocytophaga ochracea
Fusobacterium / 1 (0.5%)
1 (0.5%) / -
-
1 (1.6%) / -
Mixed culture / 2 (0.9%) / - / -
CPPE: complicated parapneumonic effusions
Table C. Clinical and laboratory characteristics of the NCTPE, CTPE and CPPE
NCTPE (n=412) / CTPE(n=137) / p1 / CPPE
(n=277) / p2
Age (years) / 40 (22) / 37 (21) / 0.120 / 59 (20) / 0.000
% of male / 277 (67.2) / 91 (66.4) / 0.861 / 212 (77) / 0.029
Cohort
Lleida / 215 (52) / 77 (56) / 176 (64)
Mendaro / 147 (36) / 36 (36) / 0.072 / 62 (22) / 0.349
Ponferrada / 50 (12) / 24 (18) / 39 (14)
Pleural fluid pH / 7.41 (0.09) / 7.27 (0.16) / 0.000 / 6.98 (0.23) / 0.000
Pleural fluid LDH (IU/L) / 858 (520) / 2686 (5312) / 0.000 / 4427 (5368) / 0.002
Pleural fluid protein (g/dL) / 5.2 (0.8) / 5.3 (1.0) / 0.215 / 4.4 (0.9) / 0.000
Pleural fluid glucose (mg/dL) / 91 (31) / 43 (22) / 0.000 / 35 (46) / 0.030
Pleural fluid leukocytes (/L / 2807 (2921) / 5779 (17880) / 0.056 / 12,073 (37,103) / 0.021
Pleural fluid mononuclear cells, % / 85 (16) / 75 (26) / 0.000 / 17 (19) / 0.000
Pleural fluid ADA (IU/L) / 62 (21) / 93 (140) / 0.000 / 55 (59) / 0.000
Diagnosis
Confirmed TBC / 145 (35) / 55 (40) / 0.297 / NA / NA
Likely TBC / 267 (65) / 82 (60) / NA
Continuous data are expressed as mean (standard deviation), and categorical variables as total number of patients (percentage).
1 NCTPE vs. CTPE
2 CTPE vs. CPPE.
ADA: adenosine deaminase, CPPE: complicated parapneumonic pleural effusion, CTPE: complicated tuberculosis pleural effusion, LDH: lactate dehydrogenase, NA: not applicable, NCTPE: non-complicated tuberculosis pleural effusion.
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