Usefulness of the Pleural Fluid Adenosine Deaminase with Lymphocyte/Neutrophil Ratio in the Diagnosis of Tuberculous Pleurisy for a Region of Intermediate Prevalence of Tuberculosis.

Kim, Chang Hwan; Mo, Eun Kyung; Park, Sung Hoon; Hwang, Yong Il; Jang, Seung Hun; Park, Yong Bum; Kim, Cheol Hong; Kim, Dong Gyu; Lee, Myung Goo; Hyun, In Gyu; Jung, Ki Suck

doi:2009.66.6.437

Tuberc Respir Dis > Volume 66(6); 2009 > Article

Original Article

Tuberculosis and Respiratory Diseases 2009;66(6):437-443.
DOI: https://doi.org/10.4046/trd.2009.66.6.437 Published online June 1, 2009.

Usefulness of the Pleural Fluid Adenosine Deaminase with Lymphocyte/Neutrophil Ratio in the Diagnosis of Tuberculous Pleurisy for a Region of Intermediate Prevalence of Tuberculosis.

Chang Hwan Kim, Eun Kyung Mo, Sung Hoon Park, Yong Il Hwang, Seung Hun Jang, Yong Bum Park, Cheol Hong Kim, Dong Gyu Kim, Myung Goo Lee, In Gyu Hyun, Ki Suck Jung

¹Department of Internal Medicine and Sejong Medical Research Institute, Sejong General Hospital, Bucheon, Korea.
²Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea. ekmo@hallym.or.kr

Abstract

BACKGROUND
The aim of this study was to consider the significance of pleural fluid adenosine deaminase (ADA) activity combined with lymphocyte/neutrophil (L/N) ratio in the diagnosis of tuberculous pleurisy (TBpl) in a region of intermediate prevalence of tuberculosis (TB). METHODS: We collected data from 388 patients with exudative pleural effusions. The final diagnoses were compared to the results from our diagnostic method using pleural fluid ADA and L/N ratio. RESULTS: 108 patients had a final diagnosis of TBpl; 102 cases had high levels of ADA (> or =40 IU/L). When we considered ADA > or =40 IU/L as a diagnostic criterion, the sensitivity was 94.4%, specificity 87.5%, and post-test probability 74.5%. However, when we considered ADA > or =40 IU/L combined with the L/N ratio > or =0.75 as a diagnostic criterion, the specificity and post-test probability were rose to 97.5% and 93%, respectively. The other causes of high ADA and L/N ratios were lymphoma and metastatic carcinoma, but mass-like lesions were found on the chest radiographs or CT scans. CONCLUSION: To evaluate the causes of exudative pleural effusions in a region of intermediate prevalence of tuberculosis, we recommend measuring the pleural fluid ADA and L/N ratio first. If the result is high and malignancies are not suspected, it may be diagnostic of TBpl.

Key Words: Adenosine deaminase, Diagnosis, Tuberculous pleurisy

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