Korean J Gastroenterol.  2021 Sep;78(3):168-176. 10.4166/kjg.2021.068.

Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis

• Dahale AS
• Puri AS
• Sachdeva S
• Agarwal AK
• Kumar A
• Dalal A
• Saxena PD

• KMID: 2520358
• DOI: http://doi.org/10.4166/kjg.2021.068

Abstract

Background/Aims
Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce.
Methods
Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively.
Results
Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L.
Conclusions
The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value.

Keyword

Tuberculosis; Liver cirrhosis; Peritonitis; Adenosine deaminase

Figure

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  Fig. 1 Study flow chart. TB, tuberculosis.

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  Fig. 2 Dot plot analysis chart of adenosine deaminase in peritoneal TB patients versus all patients with ascites. ADA, adenosine deaminase; TB, tuberculosis.

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  Fig. 3 AUC for adenosine deaminase in all peritoneal TB patients with all patients with other causes of ascites. AUC, area under the curve; TB, tuberculosis.

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  Fig. 4 Dot plot analysis chart of adenosine deaminase in peritoneal TB with cirrhosis patients versus all patients with cirrhotic ascites. ADA, adenosine deaminase; TB, tuberculosis.

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  Fig. 5 AUC for adenosine deaminase in peritoneal tuberculosis patients with cirrhosis amongst all patients with cirrhotic ascites. AUC, area under the curve; ROC, receiver operating characteristic curve; CI, confidence interval; TB, tuberculosis.

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  Fig. 6 Peritoneoscopic view showing tubercles over parietal peritoneum with adhesions.

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