ADENOSINE DEAMINASE ACTIVITY FOR THE DIAGNOSIS OF TUBERCULOSIS PLEURAL EFFUSIONS: A DIAGNOSTIC ACCURACY STUDY

  • A Duran Internal Medicine Department, Hospital General de Agudos J.M.Ramos Mejía, Buenos Aires, Argentina
  • C Alonzo Internal Medicine Department – Hospital Italiano, Buenos Aires, Argentina
  • J Gladstein Internal Medicine Department, Hospital General de Agudos J.M.Ramos Mejía, Buenos Aires, Argentina
  • M Sivori Internal Medicine Department, Hospital General de Agudos J.M.Ramos Mejía, Buenos Aires, Argentina
  • CM Patino Department of Preventive Medicine, Keck School of Medicine, University of Southern California
  • M Kalina Medical interpreter, Boston Childrens Hospital, Boston, Massachusetts, USA
  • J Tessler Internal Medicine Department – Hospital Italiano, Buenos Aires, Argentina
  • C Saenz Internal Medicine Department, Hospital General de Agudos J.M.Ramos Mejía, Buenos Aires, Argentina.
  • PA Olavegogeascoechea Departamento de Salud Colectiva, Facultad de Ciencias Médicas, Universidad Nacional del Comahue, Cipolletti, Río Negro, Argentina

Abstract

Background: the diagnosis of tuberculosis pleural effusion continues to be a challenge in clinical practice in many parts of the world. In part due to the use of diagnostic tools with poor sensitivity and specificity. Biomarkers of pleural effusion due to inflammation caused by Mycobacterium Tuberculosis such as adenosine deaminase activity has the potential to optimize the diagnostic approach of tuberculosis pleural effusion. Objective: to describe the diagnostic accuracy of adenosine deaminase activity among adult patients with pleural effusion. Design: a chart-review cross-sectional study. Methods: we retrospectively reviewed patient charts from the Internal Medicine Department Ambulatory Center in a Tertiary Care Hospital in Buenos Aires, Argentina from june-1993 to december-1995. We included 91 patients with pleural exudates in which adenosine deaminase activity measurement was performed. We evaluated the sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratios and accuracy of adenosine deaminase activity compared to the reference standard. Results: 34/91 pleural effusions were due to tuberculosis (39%). Mean +/- SD pleural effusion adenosine deaminase activity levels were higher in the tuberculosis group vs. Non tuberculosis group (99.2 ± 37.4 U/l vs.51.6 ± 68.7, p< 0.0001). The best cutoff value for pleural fluid adenosine deaminase activity using ROC curve results (AUC=0,86) was 50 u/l yielding sensitivity (97%), specificity (70%), positive predicted value 67%, negative predicted value (97%), positive likelihood ratio (3.3) and negative likelihood ratio (.04). Conclusion: given the successful use of the adenosine deaminase activity test in pleural fluid, makes this test a highly recommended option for the diagnosis approach in tuberculosis pleural effusion.

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Published
2014-11-26
How to Cite
Duran, A., Alonzo, C., Gladstein, J., Sivori, M., Patino, C., Kalina, M., Tessler, J., Saenz, C., & Olavegogeascoechea, P. (2014). ADENOSINE DEAMINASE ACTIVITY FOR THE DIAGNOSIS OF TUBERCULOSIS PLEURAL EFFUSIONS: A DIAGNOSTIC ACCURACY STUDY. European Scientific Journal, ESJ, 10(33). https://doi.org/10.19044/esj.2014.v10n33p%p