Diagnostic value of pleural fluid interferon-gamma and adenosine deaminase in patients with pleural tuberculosis in Qatar

Objective We compared diagnostic accuracy of pleural fluid adenosine deaminase (ADA) and interferon-gamma (IFN-γ) in diagnosing tuberculous pleural effusion (TPE) through systematic review and comparative meta-analysis. Methods We queried PubMed and Embase databases to identify studies providing paired data for sensitivity and specificity of both pleural fluid ADA and IFN-γ for diagnosing TPE. We used hierarchical summary receiver operating characteristic (HSROC) plots and HSROC meta-regression to model individual and comparative diagnostic performance of the two tests. Results We retrieved 376 citations and included 45 datasets from 44 publications (4974 patients) in our review. Summary estimates for sensitivity and specificity for ADA were 0.88 (95% CI 0.85–0.91) and 0.91 (95% CI 0.89–0.92), while for IFN-γ they were 0.91 (95% CI 0.89–0.94) and 0.96 (95% CI 0.94–0.97), respectively. HSROC plots showed consistently greater diagnostic accuracy for IFN-γ over ADA across the entire range of observations. HSROC meta-regression using test-type as covariate yielded a relative diagnostic odds ratio of 2.22 (95% CI 1.68–2.94) in favour of IFN-γ, along with better summary sensitivity and specificity figures. No prespecified subgroup variable significantly influenced the summary diagnostic accuracy estimates. Conclusion Pleural fluid IFN-γ estimation has better diagnostic accuracy than ADA estimation for diagnosis of TPE.

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The Utility of Pleural Fluid Lactate Dehydrogenase to Adenosine Deaminase Ratio in Pleural Tuberculosis

Respiration ◽

10.1159/000509555 ◽

2020 ◽

pp. 1-5

Author(s):

Amanda Beukes ◽

Jane Alexandra Shaw ◽

Andreas H. Diacon ◽

Elvis M. Irusen ◽

Coenraad F.N. Koegelenberg

Keyword(s):

Lactate Dehydrogenase ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Operating Characteristic ◽

Retrospective Studies ◽

Characteristic Curve ◽

Diagnostic Efficiency ◽

Pleural Tuberculosis ◽

High Incidence ◽

The Mean

In high-burden settings, the diagnosis of pleural tuberculosis (TB) is frequently inferred in patients who present with lymphocyte predominant exudative effusions and high adenosine deaminase (ADA) levels. Two recent small retrospective studies suggested that the lactate dehydrogenase (LDH)/ADA ratio is significantly lower in TB than in non-TB pleural effusions and that the LDH/ADA ratio may be useful in differentiating pleural TB from other pleural exudates. We compared the pleural LDH/ADA ratios, ADA levels, and lymphocyte predominance of a prospectively collected cohort of patients with proven pleural TB (n = 160) to those with a definitive alternative diagnosis (n = 68). The mean pleural fluid LDH/ADA ratio was lower in patients with pleural TB than alternative diagnoses (6.2 vs. 34.3, p < 0.001). The area under the receiver operating characteristic curve was 0.92 (p < 0.001) for LDH/ADA ratio and 0.88 (p < 0.001) for an ADA ≥40 U/L alone. A ratio of ≤12.5 had the best overall diagnostic efficiency, while a ratio of ≤10 had a specificity of 90% and a positive predictive value of 95%, with a sensitivity of 78%, making it a clinically useful “rule in” value for pleural TB in high incidence settings. When comparing the LDH/ADA ratio to an ADA level ≥40 U/L in the presence of a lymphocyte predominant effusion, the latter performed better. When lymphocyte values are unavailable, our data suggest that the LDH/ADA ratio is valuable in distinguishing TB effusions from other pleural exudates.

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The utility of pleural fluid lactate dehydrogenase to adenosine deaminase ratio in pleural tuberculosis

10.1183/13993003.congress-2020.1587 ◽

2020 ◽

Author(s):

Amanda Beukes ◽

Jane Alexandra Shaw ◽

Elvis M Irusen ◽

Andreas H Diacon ◽

Coenraad Frederik Nicolaas Koegelenberg

Keyword(s):

Lactate Dehydrogenase ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Pleural Tuberculosis

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Diagnostic value of the ratio of pleural fluid adenosine deaminase activity to serum adenosine deaminase activity in children with tuberculosis and non tuberculosis pleural effusion

MRIMS Journal of Health Sciences ◽

10.4103/2321-7006.302606 ◽

2014 ◽

Vol 2 (1) ◽

pp. 34

Author(s):

HKishan Reddy ◽

ASujatha Rani ◽

Prabhavati Modi

Keyword(s):

Pleural Effusion ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Diagnostic Value ◽

Adenosine Deaminase Activity

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THE APPROPRIATE CUTOFF LEVEL OF PLEURAL FLUID ADENOSINE DEAMINASE ACTIVITY BY DIAZYME COMMERCIAL KIT FOR DIAGNOSIS PLEURAL TUBERCULOSIS IN RAMATHIBODI HOSPITAL

CHEST Journal ◽

10.1378/chest.134.4_meetingabstracts.p55001 ◽

2008 ◽

Vol 134 (4) ◽

pp. 55P

Author(s):

Theerasuk Kawamatawong ◽

Kittisak Panompong ◽

Sumalee Kiatboonsri ◽

Kalayanee Khupulsup

Keyword(s):

Adenosine Deaminase ◽

Pleural Fluid ◽

Pleural Tuberculosis ◽

Adenosine Deaminase Activity ◽

Commercial Kit

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Evaluation of Polymerase Chain Reaction, Adenosine Deaminase, and Interferon-γ in Pleural Fluid for the Differential Diagnosis of Pleural Tuberculosis

CHEST Journal ◽

10.1378/chest.118.5.1355 ◽

2000 ◽

Vol 118 (5) ◽

pp. 1355-1364 ◽

Cited By ~ 95

Author(s):

Maria Virginia Villegas ◽

Luz Angela Labrada ◽

Nancy Gore Saravia

Keyword(s):

Polymerase Chain Reaction ◽

Differential Diagnosis ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Interferon Γ ◽

Chain Reaction ◽

Pleural Tuberculosis ◽

Polymerase Chain

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Diagnostic value of pleural fluid adenosine deaminase level in patients of tubercular pleural effusion

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20205479 ◽

2020 ◽

Vol 8 (1) ◽

pp. 93

Author(s):

Amit Goyal ◽

Amanpreet Kaur ◽

N. C. Kajal

Keyword(s):

Pleural Effusion ◽

Adenosine Deaminase ◽

Pleural Fluid ◽

Diagnostic Value ◽

Diagnostic Methods ◽

Common Symptom ◽

Age Group ◽

Laboratory Findings ◽

Adult Age ◽

Invasive Test

Background: The diagnosis of tuberculosis (TB) continues to be a challenge in clinical practice. Traditional diagnostic methods are very useful but don't provide enough sensitivity and specificity. Adenosine deaminase (ADA) has been developed and widely used for the diagnosis of TB. This article reviews the characteristics, metabolism and clinical uses of ADA for the diagnosis of TB in clinical practices.Methods: This study was carried out in the department of chest and TB, GMC, Amritsar, Punjab, India. In this study total 50 who attended outpatient department (OPD) and indoor patients of adult age and either sex were taken. Patients with pleural effusion as determined by clinical and or radiological means, thoracocentesis on who yield a minimum amount of fluid enough to carry out routine test were included in the study.Results: Most of the patients were between the age group of 15-34 years, of those 72% were males and 28% female. Most of the patients of tuberculous effusion were from younger age group between 25-34 years. Most common symptom was breathlessness (90%) followed by fever (75%), cough (75%) then chest pain (72%). The diagnosis of TB was made in 40 patients (80%), while in 10 patients (20%) TB were excluded (malignancy and miscellaneous disease) based on history, clinical and laboratory findings. Sensitivity of ADA in diagnosing TB pleural effusion was 95% and specificity 80%.Conclusions: ADA level of the pleural fluid is a non-invasive test. Pleural fluid ADA is useful in early diagnosing of tuberculosis pleural effusion. So the analysis of ADA levels can be done simply, quickly and cheaply.

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