Pleural Fluid Adenosine Deaminase, C -Reactive Protein levels and Lymphocyte/ Neutrophil Count Ratio in Differentiating Tubercular and Non-Tubercular Pleural Effusion

Document Type : Original Article


1 Department of Pulmonary Medicine, Graphic Era Medial College, Dehradun, India.

2 Department of Pulmonary Medicine, SGRR Medical College, Dehradun, India.

3 Department of Respiratory Medicine, Himalayan Institute of Medical Science, Swami Ram Himalayan University, Dehradun, India.


Introduction: Pleural effusion is a typical extrapulmonary cause of Tuberculosis (TB). The routine culture experiences an absence of affectability. Numerous markers in pleural fluid are assessed to analyze tubercular pleural fluid, yet no one is perfect. We have contemplated Adenosine deaminase (ADA), protein (CRP C - responsive) and Lymphocyte/Neutrophil (L/N) ratio in amalgamation for the determination of pleural effusion of tubercular origin.
Material & Methods: All patients presented with pleural effusion were put through thoracentesis and differentiated into transudative and exudative using Light's criteria. Patients with exudative pleural effusion aetiology were further bisected into two groups with a sample size of 30 patients. Group I consisted of patients with tubercular cause, and Group II comprised other than tubercular. ADA, CRP and L/N ratio of these subjects were estimated in pleural fluid. The sensitivity, specificity and predictive values were calculated.
Results: The ADA, CRP, and L/N ratio's sensitivity, specificity, positive predictive value, and negative predictive value were, respectively, 83.3%, 90.0%, 89.29%, 84.37%, 76.67%, 90.0%, 88.46%, 79.41%, 96.67%, 43.33%, 63.04%, and 92.86%. The conjunction of ADA and CRP exhibited the highest specificity for pleural effusion caused by Tuberculosis; however, both ADA and CRP showed comparable specificity on their own.
Conclusions: Diagnosing tubercular from non-tubercular individuals was made easier with the help of Pleural fluid ADA and CRP. Combining ADA, CRP, and L/N ratio does not offer any significant advantages beyond just combining ADA and CRP.


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