Source: Annual Congress 2002 - Diagnosis of tuberculosis
Disease area: Respiratory infections

Abstract

Aim: estimating the importance of measuring adenosin-deaminase (ADA) in pleural fluid for the etiologic diagnosis of pleural effusions. Method: the study included 192 patients admitted for pleurisy for 9 months. Among them, 63 had TB pleurisy, 73 neoplasia, 14 empyema, 18 transudates, 8 para-pneumonic pleurisy, 3 other causes, 7 unknown cause. Diagnosis was confirmed on pleural fluid analysis, sputum and pleural fluid bacteriology and pleural needle biopsy. ADA in pleural fluid was determined by Giusti indirect colorimetric method. Results: the cause of pleurisy was confirmed in 72% of cases. TB was confirmed in 62% and neoplasia in 77%. Mean values of ADA related to diagnosis were: higher in TB (58.4 U/l) and empyema (151.8 U/l) than in nonTB pleurisies (neoplasia - 22.9 U/l, transudates 16.7 U/l). At a threshold value of 50 U/l, the ADA sensibility (Sb) for TB diagnosis was 58.7%, lower than for nonTB cases (neoplasia-86.3%, empyema - 85.7%, parapneumonic - 75%). Specificity (Sp) was 78.9% in TB, neoplasia - 46.2%, parapneumonic - 13.08%, empyema - 86.06%. Positive predictive value (PPV) was 58.7% for TB, 49.6% for neoplasia and 42.8% for empyema. Negative predictive value (NPV) was 79.5% for TB, 84.6% for neoplasia, 98% for empyema. Conclusion: a threshold value of 40u/ml increases significantly the Sb to 71.4% for Tb pleurisy and 78.08% for neoplasia, maintaining an acceptable value of Sp (70.7% for TB, 58% neoplasia), PPV (55.5% TB, 54.8% neoplasia) and NPV (82.7% TB and 80.24% neoplasia). Measuring ADA in pleural fluid, associated to the other investigations, is a supplemental diagnostic tool with remarcable Sb and Sp.

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Citations should be made in the following way:
I. Strambu, M. Ciontu, A. Serbescu, C. Toader, I. P. Stoicescu (Bucharest, Romania). The value of adenosin-deaminase in etiologic diagnosis of pleural effusions. Eur Respir J 2002; 20: Suppl. 38, 1065

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