The Ratio Between the Percentage of Lymphocytes and Glucose Levels in Pericardial Fluid as a Method to Diagnose Tuberculous Pericarditis.
- Author:
Kyung Ho YANG
1
;
Yoon Suk SONG
;
Sun Ho JUNG
;
Tae Jin KIM
;
Shin Eui YOON
;
Yong Suk JEONG
;
Kil Hyun CHO
;
Young Bok KIM
Author Information
1. Department of Internal Medicine, Good Samaritan Hospital, Pohang, Korea. dulos2003@yahoo.co.kr
- Publication Type:Original Article
- Keywords:
Glucose;
Lymphocyte;
Tuberculous pericarditis
- MeSH:
Adenosine Deaminase;
Biomarkers;
Echocardiography;
Glucose;
Humans;
Logistic Models;
Lymphocytes;
Odds Ratio;
Pericardial Effusion;
Pericardiocentesis;
Pericarditis, Tuberculous;
Sensitivity and Specificity;
Thorax
- From:Korean Journal of Medicine
2012;83(4):458-467
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: Adenosine deaminase (ADA) is a valuable biochemical marker for pericardial effusion (PE) and may be useful for diagnosing tuberculous pericarditis (TPE) in patients with PE. However, no definite cut-off or borderline values for ADA currently exist to distinguish TPE from other PE etiologies. In this study, we identified other useful parameters and characterized their relationship with ADA as a method for diagnosing TPE. METHODS: From June 2004 to November 2011, 42 patients underwent pericardiocentesis due to moderate or severe PE, as confirmed by echocardiography or chest computed tomography (CT). Patients were subdivided into TPE and non-TPE (NTPE) groups. We analyzed ADA (p) (the pericardial ADA) and %Lymph (p)/Glucose (p) (the ratio between the percentage of lymphocytes and glucose levels in PE). RESULTS: We defined the cut-off value of ADA (p) as 48.5 IU/L, and that of %Lymph (p)/Glucose (p) as 0.678%.dL/mg. In a multivariate logistic regression analysis, an odds ratio (OR) of 44.24 and a 95% confidence interval (CI) of 2.85-686.97 were observed in patients with an ADA (p) > or = 48.5 IU/L (p = 0.023). An OR of 20.39 and a 95% CI of 1.06-392.93 were observed in patients with a %Lymph (p)/Glucose (p) > or = 0.678%.dL/mg (p = 0.046). The combination of ADA (p) and %Lymph (p)/Glucose (p) had a higher positive predictive value (PPV, 80.0%) and specificity (Sp, 93.8%) than either ADA (p) (PPV, 47.4%; Sp, 68.8%) or %Lymph (p)/Glucose (p) (PPV, 69.2%; Sp, 87.5%) alone. CONCLUSIONS: %Lymph (p)/Glucose (p) is a useful parameter for distinguishing TPE from other pericardial diseases if combined with an ADA (p) > or = 48.5 IU/L.
