Diagnostic accuracy of combined Pleural fluid Adeno sine Deaminase and Lymphocyte/Neutrophil ratio in Tubercular pleur al effusion
Abstract
Background: In India, tuberculosis is an endemic disease. Delay in diagnosis results in poor prognosis and fast spread of the disease. The objective of the present study is to look for an effective and acceptable diagnostic test, which may be helpful to initiate early treatment to improve prognosis and reduce spread. The presence of ADA in pleural fluids reflects the cellular immune response in the pleural cavity and in particularly, the activation of T lymphocytes. Objective of study include evaluating efficacy of combined use of ADA activity diagnosing tuberculous pleural effusion.
Methods: Biochemistry, cytology, and microbiology studies were performed on 164 consecutive pleural fluids. ADA were determined on all exudative effusions.
Results: Pleural fluid ADA activity at a level of ≥40 U/L, the sensitivity=95.5%, specificity=93.4%, positive prediction value=94.4%, negative prediction value=94.7% and efficacy= 94.5 %. It was statistically significant (p value<0.001).
Conclusion: ADA is a highly sensitive diagnostic marker of tubercular pleural effusion.
Downloads
References
2. Light RW, Macgregor MI, Luchsinger PC, Ball WC. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972 Oct;77(4):507–13. [PubMed]
3. Raviglione MC, Luelmo F. Update on the global epidemiology of tuberculosis. Curr Issues Public Health. 1996 Aug;2(4):192–7. [PubMed]
4. Mehta JB, Dutt A, Harvill L, Mathews KM. Epidemiology of extrapulmonary tuberculosis. A comparative analysis with pre-AIDS era. Chest. 1991 May;99(5):1134–8. [PubMed]
5. Porcel JM. Tuberculous pleural effusion. Lung. 2009 Oct;187(5):263–70. [PubMed]
6. Gupta BK, Bharat V, Bandyopadhyay D. Sensitivity, specificity, negative and positive predictive values of adenosine deaminase in patients of tubercular and non-tubercular serosal effusion in India. J Clin Med Res. 2010 May 19;2(3):121–6.
7. Valdés L, Alvarez D, San José E, Penela P, Valle JM, García-Pazos JM, et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med. 1998 Oct 12;158(18):2017–21. [PubMed]
8. Berger HW, Mejia E. Tuberculous pleurisy. Chest. 1973 Jan;63(1):88–92. [PubMed]
9. Gupta BK, Bharat V, Bandyopadhyay D. Role of Adenosine Deaminase Estimation in Differentiation of Tuberculous and Non-tuberculous Exudative Pleural Effusions. J Clin Med Res. 2010 Apr;2(2):79–84. [PubMed]
10. Chaudhary S PA. Role of pleural fluid adenosine deaminase (ADA) for the diagnosis of tuberculous pleural effusion. Calicut Med J. 2010;8:e4; 2010. [PubMed]
11. Mehta AA, Gupta AS, Ahmed S, Rajesh V. Diagnostic utility of adenosine deaminase in exudative pleural effusions. Lung India Off Organ Indian Chest Soc. 2014;31(2):142–4. [PubMed]
12. Burgess LJ, Maritz FJ, Le Roux I, Taljaard JJ. Combined use of pleural adenosine deaminase with lymphocyte/neutrophil ratio. Increased specificity for the diagnosis of tuberculous pleuritis. Chest. 1996 Feb;109(2):414–9.
OAI - Open Archives Initiative
