Adenosine Deaminase level and characteristic in tuberculous pleuritis patients in Chaiyaphum hospital
Keywords:
adenosine deaminase, tuberculous pleural effusion, lymphocytic-predominantAbstract
The diagnosis of tuberculous pleural effusion continues to be a challenge in clinical practice. Tuberculous and nontuberculous pleural effusion share similar clinical course and both produce lymphocytic-predominant exudative pleural effusion. This study aimed to describe the diagnostic accuracy of adenosine deaminase (ADA) among adult patients with lymphocytic-predominant exudative pleural effusion.
A retrospective study among 63 patients with tuberculous pleural effusion and 63 with nontuberculous pleural effusion from Chaiyaphum hospital between January 2015 and December 2017. Forty-seven (56%) tuberculous pleural effusion patients were male, mean (± SD) age was 53.1 (± 17.2) years and the mean (± SD) duration of symptom was 15.1 (±16.5) days. Fever, protein levels and lymphocyte in pleural fluid were significant higher in the tuberculosis group than non-tuberculosis group. The mean (± SD) value of ADA pleural fluid levels in the tuberculosis group was 48.3 (± 12.7) U/L, which was significantly higher than for the non-tuberculosis group (p<0.001). A receiver operating characteristic (ROC) curve identified ADA pleural fluid level of 32.7 U/L as the best cut-off value, which in turn yielded a sensitivity of 95.24% and specificity 95.24%. The positive and negative likelihood ratios at this cut-off value were 20 and 0.05, respectively.
In conclusion, the best cut-off value of ADA pleural fluid for the diagnosis of tuberculous pleural effusion in Chaiyaphum hospital was 32.7 U/L.
References
Light RW. (2010). Update on tuberculosis pleural effusion. Respirology, 15(3):451-8.
Reechaipichitkul W, Lulitanond V, Patjanasoontorn B, Kawamatawong T. (1999). Diagnostic role of pleural biopsy as compared to high volume pleural fluid study in tuberculous pleural effusion. Thai J Tuberc Chest Dis, 20(3):145-50.
Liang QL, Shi HZ, Wang K, Qin SM, Qin XJ. (2008). Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy: meta-analysis. Respir Med, 102(5):744-54.
Reechaipichitkil W, Kawamatawong T, Teerajetgul Y, Patjanasoontorn B. (2001). Diagnostic role of pleural fluid adenosine deaminase in tuberculous pleural effusion. Southeast Asian J Trop Med Pubic Health, 32(2):383-9.
Kheawon N, Anantrasertkul T, Pinyosmosorn W, Wiwatworapan T. (2008). Adenosine Diaminase activity level in exudative lymphocytic predominated pleural effusion in Maharat Nakhon Ratchasima Hospital. Nakhon Ratch Med Bull, 32:95-100.
Ibrahim WH, Ghadban W, Khinji A, Yasin R, Soub H, Al-Khal AL et al. (2005). Does pleural tuberculosis disease pattern differ among developed and developing countries. Respir Med, 99(8):1038-45.
World Health Organization. (2016). Global tuberculosis report 2016. WHO/HTM/TB/2016.13.Geneva: World Health Organization.
Levine H, Szanto PB, Cugell DW. (1968). Tuberculous pleurisy: an acute illness. Arch Intern Med, 122(4):329–32.
Moudgil H, Sridhar G, Leitch AG. (1994). Reactivation disease: the commonest form of tuberculous pleural effusion in Edinburgh,1980–1991. Respir. Med, 88(4):301–4.
Berger HW, Mejia E. (1973). Tuberculous pleurisy. Chest, 63(1):88–92.
Saiphoklang N, Kanitsap A, Nambunchu A. (2015)Differences in clinical manifestations and pleural fluid characteristics between tuberculous and malignant pleural effusions. Southeast Asian J Trop Med Public Health, 46(3):496-503.
Valdes L, Alvarez D, San Jose E, Penela P, Valle JM, García-Pazos JM, et al. (1998). Tuberculous pleurisy: a study of 254 patients. Arch Intern Med, 158(18):2017–21.
Light RW. (2007). Pleural Diseases, 5th ed. Philadelphia : Lippincott Williams & Wilkins.
Yousang L, Changhwan K, Boksoon C, Suh-Young L, So P Y, Eun-Kyung M, et al. (2017). Loculated tuberculous pleural effusion: easily identifiable and clinically useful predictor of positive mycobacterial culture from pleural fluid. Tuberc Respir Dis (Seoul), 80(1):35–44.
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