Sensitivity and Specificity of Pleural Fluid Adenosine Deaminase (ADA) and Pleural Fluid Lymphocyte/Neutrophil Ratio in the Diagnosis of Tubercular Pleural Effusion
Keywords:Tuberculosis, pleural effusion, ADA, L/N ratio, sensitivity, specificity.
Background: Pleural effusion is one of the most prevalent extrapulmonary manifestations of tuberculosis. The conventional culture method of diagnosis suffers from sensitivity. Hence, the current research was commenced with the primary aim to suggest a better diagnostic of pleural effusion of tubercular origin by assessing adenosine deaminase ADA activity in combination with lymphocyte/neutrophil (L/N) ratio than with ADA use alone. Settings and Design: Data from 60 pleural effusion study subjects were gathered using a pretested proforma, fulfilling the study objectives. Materials and Methods: A physical examination, detailed history and needed inspections were made. The diagnosis of tubercular pleural effusion was done based on the identification of bacilli in pleural fluid or culture of the fluid or radiological & clinical tuberculosis evidence and absenteeism of any other obvious cause related to pleural effusion & those who showed a positive response to antitubercular treatment. ADA was estimated for all exudative pleural fluid specimens. The specificity, sensitivity, PPV (positive predictive value) and NPV (negative predictive value) were determined to distinguish among non-tubercular and tubercular pleural effusion. Statistical analysis used: Investigations were analyzed with the clinical profile, and the data were compiled, and the appropriate statistical analysis was performed with the use of SPSS software. Results: The majority of study subjects, i.e., 26.70%, belonged to 21-30 years of age group with male predominance (51.70%) compared to females (48.30%). In 26.7% of study subjects, plural culture tested positive for mycobacterial growth. Whereas 70.0% of study subjects were diagnosed based on positive for pleural biopsy at the 50 U/L ADA level, the specificity, sensitivity, NPV, PPV and efficacy for TB identification were computed at 89.8%, 81.8%, 95.6%, 64.3%, and 88.3% correspondingly. When the added requirement of an L/N ratio of 0.75 or greater was comprised, specificity, the sensitivity, NPV, PPV and efficacy for the TB identification were computed at 95.7%, 86.9%, 93.7%, 83.3%, and 91.7%, respectively. Conclusion: It was demonstrated through this study that pleural fluid adenosine deaminase in combination with the L/N ratio has remained a valuable test in tuberculous pleuritis diagnosis.
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Copyright (c) 2021 Yogesh B Kamshette, Nagabhushan.B, Anusha G N
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