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

Authors

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.

Abstract

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.

Keywords

References

  1. Light RW. Useful tests on the pleural fluid in the management of patients with pleural effusions. Current opinion in pulmonary medicine. 1999 Jul 1;5(4):245.
  2. Marjorie PG, Holenarasipur RV. Extrapulmonary tuberculosis: An Overview. Am Fam Phy-sician, 2005 Nov 1:72(9); 1761-1768.
  3. Porcel JM. Pearls and myths in pleural fluid analysis. Respirology. 2011 Jan;16(1):44-52.
  4. Scharer L, McClement JH. Isolation of tubercle bacilli from needle biopsy specimens of parietal pleura. American Review of Respiratory Disease. 1968 Mar;97(3):466-8.
  5. Crompton GK, McHardy GF. Diseases of the respiratory system. In: Edwards CR, Boucher IA. Davidson's Principles and Practice of Medi-cine. 16th edition. Edinburgh: ELBS. 1992;410-412.
  6. Lingam J, Kandi S. Evaluation of pleural fluid interferon gamma as a diagnostic marker of tuberculous pleural effusion. Journal of Dr. NTR University of Health Sciences. 2013 Apr 1;2(2):92.
  7. Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian Journal of Medical Research. 2004 Oct 1;120(4):316.
  8. Krenke R, Safianowska A, Paplinska M, Nasilowski J, Dmowska-Sobstyl B, Bogacka-Zatorska E, et al. Pleural fluid adenosine deaminase and interferon gamma as diagnostic tools in tuberculosis pleurisy. J physiol Pharmacol. 2008 Dec 1;59(Suppl 6):349-60.
  9. Villegas MV, Labrada LA, Saravia NG. Evaluation of polymerase chain reaction, adenosine deaminase, and interferon-γ in pleural fluid for the differential diagnosis of pleural tuberculosis. Chest. 2000 Nov 1;118(5):1355-64.
  10. Burgess LJ, Maritz FJ, Le Roux I, Taljaard JF. Combined use of pleural adenosine deaminase with lymphocyte/neutrophil ratio: increased specificity for the diagnosis of tuberculous pleuritis. Chest. 1996 Feb 1;109(2):414-9.
  11. Jethani V, Sindhwani G, Mehrotra V, Kotwal A, Khanduri R. To assess diagnostic utility of pleural fluid adenosine deaminase (ADA), interferon-l (IFN) and lymphocyte/neutrophil (L/N) ratio in differentiating tubercular and non-tubercular exudative pleural effusion.
  12. Chierakul N, Kanitsap A, Chaiprasert A, Viriyataveekul R. A simple C‐reactive protein measurement for the differentiation between tuberculous and malignant pleural effusion. Respirology. 2004 Mar;9(1):66-9..
  13. Garcia-Pachon E, Soler MJ, Padilla-Navas I, Romero V, Shum C. C-reactive protein in lymphocytic pleural effusions: a diagnostic aid in tuberculous pleuritis. Respiration. 2005;72(5):486-9.
  14. TURAY ÜY, Yildirim Z, Türköz Y, Biber C, Erdoğan Y, Keyf AI, et al. Use of pleural fluid C-reactive protein in diagnosis of pleural effusions. Respiratory medicine. 2000 May 1;94(5):432-5.
  15. Yew WW, Chan CY, Kwan SY, Cheung SW, French GL. Diagnosis of tuberculous pleural effusion by the detection of tuberculostearic acid in pleural aspirates. Chest. 1991 Nov 1;100(5):1261-3.
  16. Barbas CS, Cukier A, de Varvalho CR, Barbas Filho JV, Light RW. The relationship between pleural fluid findings and the development of pleural thickening in patients with pleural tuberculosis. Chest. 1991 Nov 1;100(5):1264-7.
  17. Bueno CE, Clemente MG, Castro BC, Martín LM, Ramos SR, Panizo AG, et al. Cytologic and bacteriologic analysis of fluid and pleural biopsy specimens with Cope's needle: study of 414 patients. Archives of internal medicine. 1990 Jun 1;150(6):1190-4.
  18. Haque SS. Evaluation of adenosine deaminase (ADA) in tuberculous pleurisy. American Journal of Medicine and Medical Sciences. 2012;2(1):1-4.
  19. Aggarwal AN, Agarwal R, Sehgal IS, Dhooria S. Adenosine deaminase for diagnosis of tuberculous pleural effusion: A systematic review and meta-analysis. PloS one. 2019 Mar 26;14(3):e0213728.
  20. El-Shimy WS, Attia GA, Hazzaa SM, Mansour YM, Abd El-Halim WM. Diagnostic value of procalcitonin and C-reactive protein in differentiation between some benign and malignant pleural effusions. Egyptian Journal of Chest Diseases and Tuberculosis. 2014 Oct 1;63(4):923-30.
  21. Mahmoud FA, Rivera NI. The role of C-reactive protein as a prognostic indicator in advanced cancer. Current oncology reports. 2002 Jun;4(3):250-5.
  22. Guisti G, Galanti B. Colorimetric method In: Bergmeyer HU, ed. Method of Enzymatic analysis 3rd ed. Berlin. Germany: Verlag Chemie, Weinheim; 1984. 315–323.
  23. Burgess LJ, Maritz FJ, Le Roux I, Taljaard JF. Combined use of pleural adenosine deaminase with lymphocyte/neutrophil ratio: increased specificity for the diagnosis of tuberculous pleuritis. Chest. 1996 Feb 1;109(2):414-9.
  24. Perlepe G, Varsamas C, Petinaki E, Antonopoulos D, Daniil Z, Gourgoulianis KI. Discrimination of exudative pleural effusions based on pleural adenosine deaminase (ADA)-C-reactive protein (CRP) levels, and their combination: An observational prospective study. Journal of Personalized Medicine. 2021 Aug 30;11(9):864.
Journal of Cardio-Thoracic Medicine
Volume 10, Issue 3
September 2022
Pages 1017-1024

Files

Share

How to cite

Statistics