Authors: Greco S.¹; Girardi E.²; Masciangelo R.³; Capoccetta G.B.⁴; Saltini C.¹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 7, Number 8, August 2003 , pp. 777-786(10)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

OBJECTIVE: As Mycobacterium tuberculosis isolation rates in tuberculous effusions are relatively low, several biochemical and immunological markers have been proposed to diagnose tuberculous pleurisy including adenosine deaminase (ADA) and interferon-gamma (IFN-). Here we summarise the literature on ADA and IFN- as predictors of tuberculous pleurisy.

METHODS: After a systematic review of English language studies, we used summary receiver operating characteristic curve (SROC) analysis to determine the cumulative diagnostic accuracy of both markers and BayesÕ theorem to calculate post-test probability of disease in settings with different prevalences of tuberculous pleurisy, assessed and reported the quality of primary studies.

RESULTS: From 1978 to November 2000, studies containing sufficient data for the determination of both sensitivity and specificity were 31 on ADA, including 4738 patients, and 13 on IFN-, including 1189 patients. SROC curve yielded a maximum joint sensitivity and specificity of 93% for ADA and 96% for IFN-. In the setting of tuberculous effusion prevalence of 5%, 25% and 85%, post-test probability of a negative ADA test were 0.4%, 2.4% and 24%, and 0.22%, 1.2% and 17% for a negative IFN- test.

CONCLUSION: With the caveat that limitations in the design of the studies summarised here may distort estimates of test performance, ADA and IFN- appear to be reasonably accurate at detecting TB pleurisy.

Keywords: meta-analysis; tuberculous pleurisy; adenosine deaminase; interferon type II; laboratory techniques; procedure

Document Type: Regular paper

Affiliations: 1: Divisione Clinicizzata di Malattie Respiratorie, Università di Tor Vergata, Roma, Italy 2: Dipartimento di Epidemiologia, INMI Lazzaro Spallanzani, Roma, Italy 3: Dipartimento di Medicina Sperimentale, Università ‘La Sapienza’, Roma, Italy 4: Dipartimento Cardiorespiratorio, Università ‘La Sapienza’, Roma, Italy

Publication date: 2003-08-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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