Appropriateness of Adenosine Deaminase-Guided Management for Patients with Pericardial Effusion.
- Author:
Na Young KIM
1
;
Ji Hyun MIN
;
Jong Hwa AHN
;
Sang Young CHO
;
Eun Ju LEE
;
Seok Jae HWANG
;
Yongwhi PARK
;
Choong Hwan KWAK
;
Jin Yong HWANG
;
Jeong Rang PARK
Author Information
1. Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea. parkjrang@gmail.com
- Publication Type:Original Article
- Keywords:
Pericardial effusion;
Adenosine deaminase;
Antituberculous agents
- MeSH:
Adenosine;
Adenosine Deaminase;
Follow-Up Studies;
Granuloma;
Humans;
Incidence;
Interferons;
Medical Records;
Organophosphates;
Pericardial Effusion;
Pericarditis;
Pericarditis, Tuberculous;
Prognosis;
Recurrence;
Telephone
- From:Korean Journal of Medicine
2012;82(4):441-448
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: The prognostic impact of empirical anti-tuberculous management according to adenosine deaminase (ADA) levels in patients exhibiting pericardial effusion (PE) has not been established. We evaluated the appropriateness of ADA-guided anti-tuberculous medication for patients with PE. METHODS: From 2001 to 2010, 47 patients with PE and who were diagnosed with either tuberculous pericarditis (TbP) or idiopathic pericarditis (IP) were enrolled. The diagnosis of definite TbP was made by the presence of Tb bacilli or caseous granuloma in pericardial tissue or effusion. The diagnosis of probable TbP was made by the presence of one or more of the following: (1) elevated ADA (> or = 40 IU/L) in pericardial fluid, (2) positive Tb interferon test, or (3) extracardiac presence of Tb. All clinical information was collected by medical record review and telephone contact. RESULTS: Among the 47 patients with PE, 12 were diagnosed with definite TbP; 17, with probable TbP; and 18, with IP. The mean ADA level was significantly higher in patients with definite TbP than in patients with IP (74.97 +/- 36.79 vs. 20.14 +/- 7.39 IU/L; p < 0.001). The optimal ADA cutoff value for diagnosis of definite TbP was 64 IU/L. The median follow-up time was 12.1 months (range, 0.17-100 months). In patients with low levels of ADA (< 40 IU/L), the incidence of death or recurrence did not different between patients who were prescribed anti-tuberculous medication and those who were not. CONCLUSIONS: The ADA level in pericardial fluid was useful for making a rapid diagnosis of tuberculous pericarditis. Even in tuberculosis-endemic areas, patients with ADA < 40 IU/L may have a good prognosis without empirical anti-tuberculous treatment.
