Usefulness of the Pleural Fluid Adenosine Deaminase with Lymphocyte/Neutrophil Ratio in the Diagnosis of Tuberculous Pleurisy for a Region of Intermediate Prevalence of Tuberculosis.
10.4046/trd.2009.66.6.437
- Author:
Chang Hwan KIM
1
;
Eun Kyung MO
;
Sung Hoon PARK
;
Yong Il HWANG
;
Seung Hun JANG
;
Yong Bum PARK
;
Cheol Hong KIM
;
Dong Gyu KIM
;
Myung Goo LEE
;
In Gyu HYUN
;
Ki Suck JUNG
Author Information
1. Department of Internal Medicine and Sejong Medical Research Institute, Sejong General Hospital, Bucheon, Korea.
- Publication Type:Original Article
- Keywords:
Adenosine deaminase;
Diagnosis;
Tuberculous pleurisy
- MeSH:
Adenosine;
Adenosine Deaminase;
Humans;
Lymphoma;
Pleural Effusion;
Prevalence;
Thorax;
Tuberculosis;
Tuberculosis, Pleural
- From:Tuberculosis and Respiratory Diseases
2009;66(6):437-443
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The aim of this study was to consider the significance of pleural fluid adenosine deaminase (ADA) activity combined with lymphocyte/neutrophil (L/N) ratio in the diagnosis of tuberculous pleurisy (TBpl) in a region of intermediate prevalence of tuberculosis (TB). METHODS: We collected data from 388 patients with exudative pleural effusions. The final diagnoses were compared to the results from our diagnostic method using pleural fluid ADA and L/N ratio. RESULTS: 108 patients had a final diagnosis of TBpl; 102 cases had high levels of ADA (> or =40 IU/L). When we considered ADA > or =40 IU/L as a diagnostic criterion, the sensitivity was 94.4%, specificity 87.5%, and post-test probability 74.5%. However, when we considered ADA > or =40 IU/L combined with the L/N ratio > or =0.75 as a diagnostic criterion, the specificity and post-test probability were rose to 97.5% and 93%, respectively. The other causes of high ADA and L/N ratios were lymphoma and metastatic carcinoma, but mass-like lesions were found on the chest radiographs or CT scans. CONCLUSION: To evaluate the causes of exudative pleural effusions in a region of intermediate prevalence of tuberculosis, we recommend measuring the pleural fluid ADA and L/N ratio first. If the result is high and malignancies are not suspected, it may be diagnostic of TBpl.
