Tuberc Respir Dis.  2009 Jun;66(6):437-443.

Usefulness of the Pleural Fluid Adenosine Deaminase with Lymphocyte/Neutrophil Ratio in the Diagnosis of Tuberculous Pleurisy for a Region of Intermediate Prevalence of Tuberculosis

• Kim CH
• Mo EK
• Park SH
• Hwang YI
• Jang SH
• Park YB
• Kim CH
• Kim DG
• Lee MG
• Hyun IG
• Jung KS

Abstract

BACKGROUND: The aim of this study was to consider the significance of pleural fluid adenosine deaminase (ADA) activity combined with lymphocyte/neutrophil (L/N) ratio in the diagnosis of tuberculous pleurisy (TBpl) in a region of intermediate prevalence of tuberculosis (TB).
METHODS
We collected data from 388 patients with exudative pleural effusions. The final diagnoses were compared to the results from our diagnostic method using pleural fluid ADA and L/N ratio.
RESULTS
108 patients had a final diagnosis of TBpl; 102 cases had high levels of ADA (> or =40 IU/L). When we considered ADA > or =40 IU/L as a diagnostic criterion, the sensitivity was 94.4%, specificity 87.5%, and post-test probability 74.5%. However, when we considered ADA > or =40 IU/L combined with the L/N ratio > or =0.75 as a diagnostic criterion, the specificity and post-test probability were rose to 97.5% and 93%, respectively. The other causes of high ADA and L/N ratios were lymphoma and metastatic carcinoma, but mass-like lesions were found on the chest radiographs or CT scans.
CONCLUSION
To evaluate the causes of exudative pleural effusions in a region of intermediate prevalence of tuberculosis, we recommend measuring the pleural fluid ADA and L/N ratio first. If the result is high and malignancies are not suspected, it may be diagnostic of TBpl.

Keyword

Adenosine deaminase; Diagnosis; Tuberculous pleurisy

MeSH Terms

Adenosine
Adenosine Deaminase
Humans
Lymphoma
Pleural Effusion
Prevalence
Thorax
Tuberculosis
Tuberculosis, Pleural
Adenosine
Adenosine Deaminase

Figure

• 

  Figure 1 The receiver operator characteristic (ROC) curve for pleural fluid ADA activity. The area under the curve is 0.943.

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