Comparison of Pleural Fluid Adenosine Deaminase with the Lactate Dehydrogenase/Adenosine Deaminase Ratio in Differentiating Tubercular Pleural Effusion from Non-tubercular Effusion
Background: Pleural effusions are caused by various conditions, including tuberculosis and malignancies. Accurate differentiation between tuberculous pleural effusion (TPE) and non-tuberculous pleural effusion (NTPE) is crucial for effective treatment outcomes. While adenosine deaminase (ADA) levels...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2025-01-01
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| Series: | International Journal of Medicine and Health Development |
| Subjects: | |
| Online Access: | https://doi.org/10.4103/ijmh.ijmh_59_24 |
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| Summary: | Background: Pleural effusions are caused by various conditions, including tuberculosis and malignancies. Accurate differentiation between tuberculous pleural effusion (TPE) and non-tuberculous pleural effusion (NTPE) is crucial for effective treatment outcomes. While adenosine deaminase (ADA) levels are commonly used in diagnosing TPE, the pleural fluid LDH-to-ADA ratio is a potentially more accurate diagnostic marker. Objective: To evaluate the effectiveness of the LDH-to-ADA ratio in distinguishing between TPE and NTPE, especially in cases of increased ADA levels. Materials and Methods: This retrospective study included 80 patients who underwent their first thoracentesis with a pleural fluid ADA level of 40 IU/L or higher. Patients were categorized into TPE (n = 40) and NTPE (n = 40) groups based on clinical, radiological, and laboratory findings. Pleural fluid parameters, including LDH and ADA levels, were analyzed. Receiver operating characteristic (ROC) curve analysis was conducted to determine the diagnostic accuracy of the LDH-to-ADA ratio, with cut-off values assessed for the sensitivity and specificity. Odds ratios were calculated to evaluate the association between the LDH-to-ADA ratio and pleural effusion types. Results: ROC analysis demonstrated that the pleural fluid LDH-to-ADA ratio in comparison to the ADA levels was superior in identifying TPE, with an AUC of 0.86 (sensitivity: 75%; specificity: 90.1%), and for NTPE, with an AUC of 0.90 (sensitivity: 80%; specificity: 77.9%). The LDH-to-ADA ratio provided a strong correlation with TPE and NTPE, confirmed by both crude and adjusted odds ratios, respectively. Conclusion: The pleural fluid LDH-to-ADA ratio is a highly effective diagnostic tool for distinguishing between TPE and NTPE. It offers superior diagnostic performance compared to ADA levels alone, with well-defined cut off values enhancing its utility in clinical practice for accurate diagnosis and management of pleural effusions. |
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| ISSN: | 2635-3695 2667-2863 |