To study the diagnostic yield of pleural fluid adenosine deaminase (ADA) combined with Lymphocytic/Neutrophil (L/N) ratio in tubercular pleural effusion at a tertiary care center
Keywords:
Pleural fluid, tuberculosis, adenosine deaminaseAbstract
Introduction: Tuberculosis is one of the leading causes of death worldwide and tubercular pleural effusion is the second most common form of extrapulmonary tuberculosis after lymph node tuberculosis. The most commonly used method to diagnose exudative pleural effusion is by the help of Light’s Criteria. The goal of our study was to search for another diagnostic tool that may have a better diagnostic yield for diagnosing pleural effusion than the present methods. Material and Methods: A prospective observational study was conducted in the pulmonary medicine department of a tertiary care center over a period of 18 months, where patients with pleural effusion were enrolled in the study after proper informed consent. These effusion cases were differentiated among tubercular and non-tubercular groups by recognized methods. Among these cases, the non-tubercular patients were taken as controls. Results: A total of 45 cases were taken after considering the inclusion and exclusion criteria, with 30 tubercular effusion cases and 15 controls. The sensitivity and specificity of combined ADA & LNR were calculated to be 94.4% with a test accuracy of 89.29%. Conclusion: Our study concludes, that tubercular pleural effusion contributes substantially to the burden of disease in the world including in India.
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Abrao FC, de Abreu IR, Miyake DH, Busico MA, Younes RN. Role of adenosine deaminase and the influence of age on the diagnosis of pleural tuberculosis. Int J Tuberc Lung Dis. 2014 Nov;18(11):1363-9.
Aggarwal AN, Agarwal R, Sehgal IS, Dhooria S, Behera D. Meta-analysis of Indian studies evaluating adenosine deaminase for diagnosing tuberculous pleural effusion. Int J Tuberc Lung Dis. 2016 Oct;20(10):1386-91.
Akturk U, Ernam D, Akbay M, Koçak N, Ogur E, Irmak I. Role of the Neutrophil-Lymphocyte Ratio in the Differential Diagnosis of Exudative Pleural Effusion. Clinics. 2016;71(10):611-61.
Antin SS, Kashinkunti M, Darshana R, Dhananjaya M. Use of Pleural Fluid Lymphocyte Neutrophil Ratio in Addition to Pleural Fluid Adenosine Deaminase for the Diagnosis of Tuberculous Pleural Effusion. Sch J App Med Sci 2014; 2(2A):498-501.
Behera BK, Sathish K TN. Role of adenosine deaminase and lymphocyte/neutrophil ratio in the diagnosis of tuberculous pleural effusion in patients with exudative pleural effusion. Int J Res Med Sci 2018; 6:144-8.
Burgess L, Maritz F, Roux I, Taljaard J. Combined Use of Pleural Adenosine Deaminase with Lymphocyte/Neutrophil Ratio. Chest. 1996;109(2):414-9.
Dharampal, Sharma A. Study of Pleural Fluid Adenosine Deaminase Levels in Subjects with Tubercular and Non-Tubercular Pleural Effusion. Galore International Journal of Health Sciences and Research. 2020;5(2):21-5.
Division CT. India Tb Report National Tuberculosis. 2022; p3-10. Available from: https://tbcindia.gov.in/showfile.php?lid=3538
Epstein DM, Kline LR, Albelda SM, Miller WT. Tuberculous pleural effusions. Chest. 1987 Jan 1;91(1):106-9.
Escudero Bueno C, García Clemente M, Cuesta Castro B, Molinos Martín L, Rodríguez Ramos S, González Panizo A, et al. Cytologic and bacteriologic analysis of fluid and pleural biopsy specimens with Cope's needle. Study of 414 patients. Arch Intern Med. 1990 Jun;150(6):1190-4.
GakisC. Adenosine deaminase (ADA) isoenzymes ADA1 and ADA2: diagnostic and biological role. European Respiratory Journal. 1996;9(4):632-3.
Goto M, Noguchi Y, Koyama H, Hira K, Shimbo T, Fukui T. Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis. Ann Clin Biochem. 2003 Jul;40(Pt 4):374- 81.
Greco S, Girardi E, Masciangelo R, Capoccetta GB, Saltini C. Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: a meta-analysis. Int J Tuberc Lung Dis. 2003 Aug;7(8):777-86.
Hooper C, Lee YC, Maskell N; BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010 Aug;65 Suppl 2: ii4-17.
Kang JY, Rhee CK, Kang NH, Kim JS, Yoon HK, Song JS. Clinical Utility of Two Interferon-gamma Release Assays on Pleural Fluid for the Diagnosis of Tuberculous Pleurisy. Tuberc Respir Dis (Seoul). 2012 Sep;73(3):143-50.
Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and management. Open Access Emerg Med. 2012 Jun 22; 4:31-52.
Keng LT, Shu CC, Chen JY, Liang SK, Lin CK, Chang LY, et al. Evaluating pleural ADA, ADA2, IFN-γ and IGRA for diagnosing tuberculous pleurisy. J Infect. 2013 Oct;67(4):294-302.
Liang QL, Shi HZ, Wang K, Qin SM, Qin XJ. Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy: a meta-analysis. Respir Med. 2008 May;102(5):744-54.
Light R. Pleural Diseases. Philadelphia: Wolters Kluwer; 2015.
Novoa, R. B. (2021). State of the art and future applications of digital health in Chile. International Journal of Health & Medical Sciences, 4(3), 355-361. https://doi.org/10.31295/ijhms.v4n3.1772
Ogata Y, Aoe K, Hiraki A, Murakami K, Kishino D, Chikamori K, et al. Is adenosine deaminase in pleural fluid a useful marker for differentiating tuberculosis from lung cancer or mesothelioma in Japan, a country with intermediate incidence of tuberculosis? Acta Med Okayama. 2011 Aug;65(4):259-63.
Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults. Am Fam Physician. 2006 Apr 1;73(7):1211-20.
Ruan SY, Chuang YC, Wang JY, Lin JW, Chien JY, Huang CT, Kuo YW, Lee LN, Yu CJ. Revisiting tuberculous pleurisy: pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area. Thorax. 2012 Sep;67(9):822-7.
Sharma SK, Ryan H, Khaparde S, Sachdeva KS, Singh AD, Mohan A, et al. Index-TB guidelines: Guidelines on extrapulmonary tuberculosis for India. Indian J Med Res. 2017;145(4):448-63
Su SB, Qin SY, Guo XY, Luo W, Jiang HX. Assessment by meta-analysis of interferon-gamma for the diagnosis of tuberculous peritonitis. World J Gastroenterol. 2013 Mar 14;19(10):1645-51.
Suresh R, Premkumar VT. To study the combined use of pleural fluid lymphocyte/neutrophil ratio and ADA for the diagnosis of tubercular pleural effusion. International Archives of Integrated Medicine 2017; 4(9): 1-5.
Suryasa, I. W., Rodríguez-Gámez, M., & Koldoris, T. (2021). Health and treatment of diabetes mellitus. International Journal of Health Sciences, 5(1), i-v. https://doi.org/10.53730/ijhs.v5n1.2864
Tay TR, Tee A. Factors affecting pleural fluid adenosine deaminase level and the implication on the diagnosis of tuberculous pleural effusion: a retrospective cohort study. BMC Infect Dis. 2013 Nov16; 13:546.
Valdés L, San José ME, Pose A, Gude F, González-Barcala FJ, Alvarez-Dobaño, et al. Diagnosing tuberculous pleural effusion using clinical data and pleural fluid analysis A study of patients less than 40 years-old in an area with a high incidence of tuberculosis. Respir Med. 2010 Aug;104(8):1211-7.
Verma SK, Dubey AL, Singh PA, Tewerson SL, Sharma D. Adenosine Deaminase (ADA) Level in Tubercular Pleural Effusion. Lung India. 2008 Jul;25(3):109-10.
World Health Organization (WHO). Global tuberculosis report 2021. Geneva: WHO; 2022. Available from: https://www.who int/tb/publications/global_report/en/
Wu YB, Ye ZJ, Qin SM, Wu C, Chen YQ, Shi HZ. Combined detections of interleukin 27, interferon-γ, and adenosine deaminase in pleural effusion for diagnosis of tuberculous pleurisy. Chin Med J (Engl). 2013;126(17):3215-21.
Zarić B, Kuruc V, Milovančev A, Markovic M, Šarčev T, Čanak V, Pavlović S. Differential diagnosis of tuberculous and malignant pleural effusions: what is the role of adenosine deaminase? Lung. 2008 Jul- Aug;186(4):233-40.
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