Diagnostic validity of weighted diagnostic index scores for tuberculous meningitis in adults

Dong Sik Jung,; You Jeong Oh,; Ki Tae Kwon,; Ji Young Rhee,; Sang Yop Shin,; Hae Suk Cheong,; Nam Yong Lee,; Hyuck Lee,; Doo Ryeon Chung,; Kyong Ran Peck,; Jae-Hoon Song,

Korean J Med > Volume 75(3); 2008 > Article

Original Article

The Korean Journal of Medicine 2008;75(3):316-321.

Diagnostic validity of weighted diagnostic index scores for tuberculous meningitis in adults

Dong Sik Jung, You Jeong Oh, Ki Tae Kwon, Ji Young Rhee, Sang Yop Shin, Hae Suk Cheong, Nam Yong Lee, Hyuck Lee, Doo Ryeon Chung, Kyong Ran Peck, Jae-Hoon Song

을지의과대학교 내과학교실1, 흉부외과학교실2, 영상의학교실3, 병리학교실5

원저: 결핵성 수막염 진단을 위한 지표의 타당성 평가

정동식&#;오유정&#;권기태&#;이지영&#;신상엽&#;정혜숙&#;이남용&#;이 혁&#;정, You Jeong Oh, Ki Tae Kwon, Ji Young Rhee, Sang Yop Shin, Hae Suk Cheong, Nam Yong Lee, Hyuck Lee, Doo Ryeon Chung, Kyong Ran Peck, Jae-Hoon Song

Abstract

Background/Aims: Tuberculous meningitis is a common, occasionally fatal infectious disease of the central nervous system. We evaluated the diagnostic validity of weighted diagnostic index scores (WDIS), which have been suggested to aid in the diagnosis of adult patients with tuberculous meningitis, on the basis of simple clinical and laboratory findings. Methods: The microbiological and clinical data of adult patients with either tuberculous or bacterial meningitis were reviewed retrospectively. Diagnostic validity and WDIS cut-off values were evaluated by receiver operating characteristic (ROC) curve analysis. Results: A total of 77 cases were included: 47 with tuberculous meningitis and 30 with bacterial meningitis. For the diagnosis of tuberculous meningitis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of WDIS suggested by Thwaites (cut-off value of ≤ 4) were 100, 90, 94 and 100%, respectively. Based on ROC curve analysis (area under ROC curve = 0.993), a cut-off value of ≤ 3 was most appropriate for the diagnosis of tuberculous meningitis. The sensitivity and specificity of WDIS with a cut-off value of ≤ 3 were 100 and 93.3%, respectively. Conclusions: Our study demonstrated that WDIS are highly predictable and acceptable for the early diagnosis of tuberculous meningitis in Korea, based on our analysis of clinical and laboratory findings. A cut-off value of ≤ 3 showed the best diagnostic validity. (Korean J Med 75:316-321, 2008)

Key Words: Tuberculous meningitis; Diagnostic validity.