| Diagnostic performance of adenosine deaminase activity in pleural fluid: a single-center experience with over 2100 consecutive patients. | |
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MedLine Citation:
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PMID: 20816597 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To determine the diagnostic utility of adenosine deaminase (ADA) in a large series of pleural effusions of different etiologies. METHODS: A retrospective study of 2104 consecutive patients presenting with pleural effusion was carried out at a Spanish university hospital. ADA levels in pleural fluid were determined using a non-Giusti automatic kinetic assay, and a receiver operating characteristics curve analysis was applied to estimate their discriminative properties. RESULTS: Pleural tuberculosis (TB) accounted for 221 (10.5%) effusions. Pleural fluid ADA >35U/L yielded 93% sensitivity, 90% specificity, a positive likelihood ratio (LR) of 10.05 and a negative LR of 0.07 for the diagnosis of TB among lymphocytic exudates. The ADA activity was significantly higher in neutrophil- (111.6U/L) than in lymphocyte-rich (62.4U/L; p=0.002) TB effusions. Overall, more than 40% of parapneumonics and half of lymphomatous effusions exceeded the cutoff set for TB. These were the only causes of ADA activity above 250U/L. When the prevalence of TB as a cause of exudative effusions is low (e.g., 1%), the estimated positive predictive value of the ADA test may be as low as 7%, although the negative predictive value remains high (99.9%). CONCLUSION: Where available, pleural ADA should be routinely used to rule TB in or out in areas with moderate to high or low TB prevalence, respectively. A high ADA level is a characteristic not only of lymphocytic, but also of neutrophilic TB effusions. An extremely high ADA activity should raise suspicion of empyema or lymphoma. |
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Authors:
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José M Porcel; Aureli Esquerda; Silvia Bielsa |
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Publication Detail:
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Type: Journal Article Date: 2010-05-01 |
Journal Detail:
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Title: European journal of internal medicine Volume: 21 ISSN: 1879-0828 ISO Abbreviation: Eur. J. Intern. Med. Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-06 Completed Date: 2010-12-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9003220 Medline TA: Eur J Intern Med Country: Netherlands |
Other Details:
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Languages: eng Pagination: 419-23 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. |
Affiliation:
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Pleural Diseases Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica de Lleida, Avda. Alcalde Rovira Roure 80, Lleida, Spain. jporcelp@yahoo.es |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adenosine Deaminase
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metabolism* Adult Aged Aged, 80 and over Biological Markers / metabolism* Empyema / diagnosis, epidemiology, metabolism Enzyme Activation / physiology False Positive Reactions Humans Lymphoma / diagnosis, epidemiology, metabolism Middle Aged Pleural Effusion, Malignant / diagnosis*, epidemiology, metabolism* Predictive Value of Tests Prevalence Retrospective Studies Sensitivity and Specificity Tuberculosis, Pleural / diagnosis*, epidemiology, metabolism* Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; EC 3.5.4.4/ADA protein, human; EC 3.5.4.4/Adenosine Deaminase |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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