diagnostic accuracy of pleural fluid tumor necrosis factor ? in tuberculous pleurisy: a meta-analysis

background: pleurisy is a common extra pulmonary complication of tuberculosis, but current methods for diagnosing it are fairly crude. here we product a meta-analysis for the available evidence on the ability of tumor necrosis factor-? (tnf-?) in pleural fluid to serve as a diagnostic marker of tuberculous pleurisy (tp). materials and methods: we searched the pubmed, embase, and google scholar databases systematically for studies measuring sensitivity, specificity and other measures of diagnostic accuracy of pleural fluid tnf-? in the diagnosis of tp were meta-analyzed by stata, version 12 and meta-disc. results: a total of six publications reporting seven case-control studies were identified. pooled results indicated that pleural fluid tnf-? showed a diagnostic sensitivity of 0.89 (95% confidence interval [95% ci] 0.83-0.93; range, 0.42-1.0) and a diagnostic specificity of 0.82 (95% ci: 0.78-0.86; range, 0.58-0.98). the pooled positive likelihood ratio was 4.78 (95% ci: 3.32-6.89); the negative likelihood ratio, 0.16 (95% ci: 0.1-0.27); the diagnostic odds ratio, 32.43 (95% ci: 14.48-72.6); and the area under the curve was 0.8556 (standard error of mean 0.0559). conclusion: pleural fluid tnf-? levels shows relatively high sensitivity but insufficient specificity for diagnosing tp. pleural fluid tnf-? measurement may be useful in combination with clinical manifestations and conventional tests such as microbiological examination or pleural biopsy.