Risk Factors for High Mesothelial Cell Counts in HIV-negative Patients With Tuberculous Pleural Effusion
Journal
Journal of the Formosan Medical Association
Journal Volume
109
Journal Issue
6
Pages
456-462
Date Issued
2010
Author(s)
Abstract
Background/Purpose: Higher mesothelial cell counts (HM) greater than 5% of total cell counts in tuberculous pleural effusions (TBPE) have been described in human immunodeficiency virus (HIV)-infected patients, however the nature and risk factors in HIV-negative patients with TBPE are unknown. The purpose of the study was to characterize the clinical manifestation of HM in HIV-negative patients with TBPE and evaluate the risk factors of developing HM-TBPE. Methods: This retrospective study was undertaken in HIV-negative patients with TBPE from the Far Eastern Memorial Hospital Tuberculosis database. The cytologist and examining specialist differentiated and quantified the cell counts. HM-TBPE was defined when more than 5% of total cell counts in the pleural fluid were mesothelial cells. Multivariate analysis was calculated with stepwise logistic regression for HM-TBPE risk factors. Results: Nineteen patients were diagnosed as HM-TBPE, while 30 were diagnosed with lower mesothelial cell counts TBPE (LM-TBPE). Compared with LM-TBPE patients, those with HM-TBPE had significantly decreased hemoglobin and serum albumin levels (p<0.05). Organ dysfunction such as congestive heart failure, liver cirrhosis and renal failure was significantly more common in patients with HM-TBPE (47.4%) than in patients with LM-TBPE (13.3%; p=0.01). Multivariate analysis revealed that independent risk factors for developing HM-TBPE included hypoalbuminemia (odds ratio =1.6; 95% confidence interval = 1.1-13.8) and the presence of organ dysfunction (odds ratio =4.5; 95% confidence interval = 1.4-17.5). Conclusion: Baseline hypoalbuminemia and comorbidities were independent risk factors for development of HM-TBPE in HIV-negative patients. Mesothelial cell counts should not be used alone in the diagnosis of TBPE. An understanding of the organ dysfunction associated with HM-TBPE in HIV-negative patients could avoid delayed diagnosis and treatment of tuberculosis. ? 2010 Formosan Medical Association & Elsevier.
SDGs
Other Subjects
albumin; hemoglobin; adult; aged; albumin blood level; article; cell count; cell differentiation; clinical article; confidence interval; congestive heart failure; cytology; female; hemoglobin blood level; human; Human immunodeficiency virus; hypoalbuminemia; kidney failure; liver cirrhosis; logistic regression analysis; male; mesothelium cell; multiple organ failure; multivariate analysis; pleura effusion; retrospective study; risk factor; tuberculosis; Adult; Aged; Biopsy; Cell Count; Diagnosis, Differential; Epithelial Cells; Female; HIV Seronegativity; Humans; Male; Middle Aged; Pleural Effusion; Retrospective Studies; Risk Factors; Tuberculosis, Pleural
Type
journal article