Ziaullah, Sajjad Ali, Muhammad Rafiq, Saeed Khan, Anila Basit, Zafar Iqbal, Muhammad Yousaf Khan, Arshad Javaid.
Diagnostic accuracy of pleural fluid adenosine deaminase in patients wiht tuberculous pleural effusion keeping closed pleural biopsy as a gold standard.
Pak J Chest Med Jan ;21(2):47-53.

BACKGROUND AND OBJECTIVE: Tuberculosis (TB) and malignancy are the most common causes of exudative pleural effusion, which usually has lymphocytic and exudative characteristics. Adenosine Deaminase (ADA) is a useful biochemical marker for the diagnosis of tuberculous pleural effusion (TPE). The aim of this study was to determine the diagnostic accuracy of pleural fluid ADA in patients with tuberculous pleural effusion while keeping pleural biopsy as a gold standard. STUDY DESIGN, PLACE AND DURATION: It was a Cross-sectional (validation) study conducted in Pulmonology Department, Post Graduate Medical Institute, Lady Reading Hospital (PGMI/LRH), Peshawar, from March 28, 2011 to September, 27 2011. MATERIALS AND METHODS: All the patients with pleural effusion fulfilling inclusion criteria were subjected to thoracentesis and Abrams needle biopsy. Pleural fluid was sent to laboratory for measurement of ADA using commercially available ADA kit DIAZYME (Diazyme laboratories Poway, CA 92064, USA) while pleural tissue was sent for histopathological examination. All the investigations were performed by the laboratory to avoid any observer bias. Results: Out of 144 patients 84 (58.3%) were males and 60 (41.7%) were females. Mean age was 47.21+17.85 SD years. In 84 (58.3%) patients, pleural biopsy was suggestive of tuberculosis. In biopsy proven tuberculous pleural effusion (TPE) pleural fluid ADA ranged from 20-130 U/L with mean pleural fluid ADA level of 53.93 +16.12 U/L. In non TB pleural effusion (NTPE), pleural fluid ADA ranged from 10-75 U/L with mean pleural fluid ADA level of 33.25+ 14.65 U/L. Taking pleural biopsy as gold standard and taking ADA level > 40 U/L as cut off value, the sensitivity, specificity, PPV and NPV of pleural fluid ADA level in the diagnosis of TPE were 90.47% , 76.66%, 84.44% and 85.18% respectively. CONCLUSION: In appropriate clinical setting pleural fluid ADA level is a useful biochemical marker which aids in the diagnosis of Tuberculous pleural effusion.

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