The Combined Utility of Pleural Fluid Adenosine Deaminase and Biomarkers for Differentiating Exudative Pleural Effusion

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Background: Despite of having some similar clinical features, tuberculous and malignant pleural effusion remarkably differ from each other regarding pathophysiology, biochemical basis and management. Hence, their accurate diagnosis is prompt for effective and timely management. Methods: It was an analytical cross-sectional study conducted at the Department of Pulmonology Sahiwal Teaching Hospital Pakistan over 6 months(May - Oct 2025). Total 320 patients of exudative pleural effusion were included and divided into two groups. Group1(n=186) consisted of tuberculous pleural effusion and group2(n=134) contained consisted of exudative pleural effusion. After taking informed written consent, demographic and clinical data was noted on structured proforma and adenosine deaminase, lactate dehydrogenase and glucose levels were estimated and compared among both groups via SPSS version 25. Results: Tuberculosis pleural effusion was largely found in group1. Chest pain and cough was also frequently observed in group1.Pleural fluid adenosine deaminase and lactate dehydrogenase were significantly higher and glucose levels were significantly lower in group1 as compare to group 2. Analysis of Receiver Operating Characteristic (ROC) curve indicated that diagnostic ability of adenosine deaminase is highest among three biomarkers. Regression analysis validated that all three biochemical markers had independent association with the diagnosis of tuberculous pleural effusion (p ≤ 0.005). Conclusion: Combine assessment of relevant clinical features with pleural fluid adenosine deaminase, lactate dehydrogenase and glucose may enhance the diagnostic differentiation of tuberculous pleural effusion from malignant pleural effusion.