Key result
Pleural fluid adenosine deaminase thresholds of ≥15 and ≥30 U/L yielded negative predictive values of 100% and 99.7% for tuberculous pleural effusion in a low-incidence setting.
Why the study?
What is the diagnostic performance of pleural fluid adenosine deaminase for tuberculous pleural effusion in a low-incidence setting?
Observational
What is the diagnostic performance of pleural fluid adenosine deaminase for tuberculous pleural effusion in a low-incidence setting?
In a low-TB-incidence setting, the primary clinical utility of pleural fluid adenosine deaminase testing is its high negative predictive value for ruling out tuberculous pleural effusion.
High pfADA NPV may aid ruling out tuberculous pericarditis; retrospective data leaves open prospective validation before clinical use.
values (that is, receiver operating characteristic [ROC] curve analysis with determination of the ROC area under the curve) were 0.93 and 0.94, respectively. The pfADA thresholds of ≥15 and ≥30 U/liter demonstrated sensitivities of 100% (95% confidence internal = 93.7 to 100) and 93.0% (83.3 to 97.2), specificities of 62.7% (60.3 to 65.0) and 87.3% (85.6 to 88.9), positive predictive values (PPVs) of 8.8% (6.9 to 11.2) and 20.9% (16.4 to 26.4), and negative predictive values (NPVs) of 100% (99.6 to 100) and 99.7% (99.3 to 99.9), respectively. LD/ADA ratio thresholds of <25 and <15 demonstrated sensitivities of 100% (93.5 to 100) and 89.1% (78.2 to 94.9), specificities of 61.6% (59.1 to 64.0) and 84.8% (82.9 to 86.5), PPVs of 8.5% (6.6 to 10.9) and 17.3% (13.3 to 22.0), and NPVs of 100% (99.6 to 100) and 99.5% (99.0 to 99.8), respectively. A combination of pfADA ≥ 30 U/liter and an LD/ADA ratio < 15 increased the specificity and PPV to 97.8% (96.9 to 98.4) and 57.3% (46.5 to 67.5) but decreased the sensitivity to 85.5% (73.8 to 92.4). The primary value of pfADA in a low-TB-incidence setting, such as Auckland, is in utilization of its high NPV.
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Blakiston et al. (2018) conducted an observational in Tuberculous Pleural Effusion. Pleural fluid adenosine deaminase (pfADA) was evaluated on Diagnostic performance (sensitivity, specificity, PPV, NPV). Pleural fluid adenosine deaminase thresholds of ≥15 and ≥30 U/L yielded negative predictive values of 100% and 99.7% for tuberculous pleural effusion in a low-incidence setting.
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