Factors affecting pleural fluid adenosine deaminase level and the implication on the diagnosis of tuberculous pleural effusion: a retrospective cohort study

BMC Infectious Diseases

Augustine Tee¹  Tunn Ren Tay¹ 

[1] Department of Respiratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore

关键词: Biological markers;    Pleural effusion;    Tuberculosis;    Adenosine deaminase;   

Others  :  1145373
DOI  :  10.1186/1471-2334-13-546

 received in 2013-06-03, accepted in 2013-11-12,  发布年份 2013

【 摘 要 】

Background

Adenosine deaminase (ADA) is useful in the diagnosis of tuberculous pleural effusion (TPE). This study aims to determine the factors affecting pleural fluid ADA levels and to establish the optimal ADA levels for diagnosis of TPE for different age groups.

Methods

This was a retrospective study from January 2007 to October 2011. One hundred and sixty patients who had pleural fluid ADA performed for investigation of pleural effusion were analyzed. Variables examined included demographics, pleural fluid characteristics and peripheral blood counts. The ADA cut-offs according to age were selected using the receiver operating characteristic (ROC) curve.

Results

The mean pleural fluid ADA was significantly higher in the TPE group (100 ± 35 IU/L) compared to non TPE patients (30 ± 37 IU/L). There was significant correlation between pleural fluid ADA and age, pleural fluid protein, LDH, and fluid absolute lymphocyte count. The strongest correlation was seen with age (r = −0.621). For patients ≤ 55 years old the ROC for ADA had area under curve (AUC) of 0.887. A pleural fluid ADA of 72 IU/L had sensitivity of 95.1%, specificity of 87.5%, positive predictive value (PPV) of 95.1% and negative predictive value (NPV) of 87.5% for the diagnosis of TPE. For patients > 55 years old the AUC is 0.959. ADA of 26 IU/L had a sensitivity of 94.7%, specificity of 80.4%, PPV of 62% and NPV of 97.8%.

Conclusions

There is a significant negative correlation between pleural fluid ADA and age. For older patients, a lower ADA cut-off should be used to exclude TPE.

【 授权许可】

   
2013 Tay and Tee; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Light RW: Pleural Diseases. 5th edition. Philadelphia: Lippincott Williams & Wilkins; 2007.
• [2]Sahn SA: Getting the most from pleural fluid analysis. Respirology 2012, 17:270-277.
• [3]Valdes L, Alvarez D, Valle JM, Pose A, v E: The etiology of pleural effusions in an area with high incidence of tuberculosis. Chest 1996, 109:158-162.
• [4]Liam CK, Lim KH, Wong CM: Causes of pleural exudates in a region with a high incidence of tuberculosis. Respirology 2000, 5:33-38.
• [5]Valdes L, Alvarez D, San José E, Penela P, Valle JM, García-Pazos JM, Suárez J, Pose A: Tuberculous pleurisy: study of 254 patients. Arch Intern Med 1998, 158:2017-2021.
• [6]Valdes L, San José E, Alvarez D, et al.: Diagnosis of tuberculous pleurisy using the biologic parameters adenosine deaminase, lysozyme, and interferon gamma. Chest 1993, 103:458-465.
• [7]Gopi A, Madhavan SM, Sharma SK, Sahn SA: Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest 2007, 131:880-889.
• [8]Baganha MF, Pego A, Lima MA, Gaspar EV, Cordeiro AR: Serum and pleural adenosine deaminase: correlations with lymphocytic populations. Chest 1990, 97:605-610.
• [9]Niwa Y, Kishimoto H, Shimokata K: Carcinomatous and tuberculous pleural effusions: comparison of tumour markers. Chest 1985, 87:351-355.
• [10]Riantawan P, Chaowalit P, Wongsangiem M, Rojanaraweewong P: Diagnostic value of pleural fluid adenosine deaminase in tuberculouspleuritis with reference to HIV coinfection and a Bayesian analysis. Chest 1999, 116:97-103.
• [11]Yeon KM, Kim CJ, Kim JS, Kim CH: Influence of age on the adenosine deaminase activity in patients with exudative pleural effusion. Tuberculosis Respir Dis 2002, 53:530-541.
• [12]Valdes L, Alvarez D, San Jose E, Juanatey J, Pose A, Valle JM, Salgueiro M, Suarez J: Value of adenosine deaminase in the diagnosis of tuberculous pleural effusions in young patients in a region of high prevalence of tuberculosis. Thorax 1995, 50:600-603.
• [13]Merino JM, Carpintero I, Alvarez T, Rodrigo J, Sanchez J, Coello JM: Tuberculous pleural effusion in children. Chest 1998, 115:26-30.
• [14]Lee YC, Rogers JT, Rodriguez RM, Miller KD, Light RW: Adenosine deaminase levels in nontuberculous lymphocytic pleural effusions. Chest 2001, 120:356-361.
• [15]Kashiwabara K, Okamoto T, Yamane H: When pleural potassium exceeds 5.0 mEq/L, high pleural adenosine deaminase levels do not necessarily indicate tuberculouspleuritis. Respirology 2012, 17:92-98.
• [16]Baba K, Hoosen AA, Langeland N, Dyrhol-Riise A: Adenosine deaminase activity is a sensitive marker for the diagnosis of tuberculouspleuritis in patients with very low CD4 counts. PloseOne 2008, 3:1-5.
• [17]Valdes L, San Jose E, Alvarez D, Valle JM: Adenosine deaminase (ADA) isoenzyme analysis in pleural effusions: diagnostic role, and relevance to the origin of increased ADA in tuberculous pleurisy. Eur Resp J 1996, 9:747-751.
• [18]Desai A, Grolleau-Julius A, Yung R: Leukocyte function in the aging immune system. J Leukoc Biol 2010, 87:1001-1009.