The diagnostic utility of pleural fluid adenosine deaminase for tuberculosis in a low prevalence area

• DOI: 10.5588/ijtld.16.0803
• Publication Date: 2017-07-21T03:35:31Z
• Authors: P. Sivakumar; L. Marples; R. Breen; L. Ahmed
• Keywords: Interquartile range; Positive predicative value

Pleural fluid adenosine deaminase (pfADA) is not routinely measured in patients with undiagnosed pleural effusion due to limited evidence of its diagnostic utility areas low tuberculosis (TB) prevalence.We conducted a retrospective consecutive case series analysis all who underwent pfADA testing from 2009 2015 at tertiary service centre south London. Using receiver operating characteristic (ROC) curve analysis, we identified the optimal threshold which maximal sensitivity and specificity were achieved.Of 132 tested for pfADA, 27 had confirmed TB 105 did not, median levels respectively 63 IU/l (interquartile range [IQR] 47-88) 12 (IQR 7.5-22.5). ROC determined cut-off be 30 IU/l, positive negative predictive values 60.5% 98.9%, 96.3% (95%CI 0.892-1.000) 83.8% 0.768-0.909). The calculated area under was 0.934 0.893-0.975).A level <30 makes diagnosis highly unlikely South London population. Its high make valuable screening test excluding suspected TB.