The diagnostic utility of adenosine deaminase isoenzymes in tuberculous pleural effusions
OBJECTIVE: To estimate the diagnostic accuracy of ADA and ADA2 in diagnosing tuberculous pleurisy.
METHOD: A 3-year retrospective study was carried out. ADA and ADA2 were determined on patients diagnosed according to predetermined criteria.
RESULTS: A total of 951 samples were received, including 387 patients with tuberculosis (TB). ADA values ≥52.4 U/l yielded a sensitivity, specificity and positive (PPV) and negative predictive value (NPV) respectively of 93.7% (95%CI 90.0–96.0), 88.7% (95%CI 85.7–91.3), 85.5% (95%CI 81.7–88.8) and 95.2% (95%CI 92.9–96.9). ADA2 values ≥40.6 U/l yielded a sensitivity, specificity and PPV and NPV of respectively 97.2% (95%CI 95.0–98.7), 94.2% (95%CI 91.8–96.0), 92.2% (95%CI 89.1–94.7) and 98.0% (95%CI 96.3–99.0). The χ2 and McNemar tests proved the superiority of ADA2 statistically.
CONCLUSION: ADA2 is superior to ADA in the diagnosis of tuberculous pleuritis and should be used as a routine test in the diagnostic work-up of patients with pleural effusions in areas with high TB prevalence.
Document Type: Regular Paper
Affiliations: 1: Division of Chemical Pathology, National Health Laboratory Service, Tygerberg Hospital, Stellenbosch University, Parow, Tygerberg, South Africa 2: TREAD Research/Cardiology Unit, Department of Internal Medicine, Tygerberg Hospital, Stellenbosch University, Parow, Tygerberg, South Africa
Publication date: February 1, 2009
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