Systematic review/Meta-analysis Diagnostic accuracy of adenosine deaminase for tuberculous peritonitis: a meta-analysis

Abstract

IntroductionTuberculous peritonitis remains a diagnostic challenge for clinicians. Many studies have investigated the usefulness of adenosine deaminase (ADA) in ascites for the diagnosis of tuberculous peritonitis; however, the overall diagnostic accuracy of ADA for tuberculous peritonitis remains unclear. The aim of the present meta-analysis was to determine the overall accuracy of ADA measurements in the diagnosis of tuberculous peritonitis.Material and methodsWe performed a systematic search in PubMed and Embase to identify published studies that evaluated the diagnostic role of ADA for tuberculous peritonitis. Quality was assessed according to standardized Quality Assessment of Diagnostic Accuracy Studies criteria. Sensitivity, specificity and other measures of accuracy of ADA assay in order to diagnose tuberculous peritonitis were pooled using random effects models. Summary receiver operating characteristic curve (SROC) was used to summarize overall test performance.ResultsSixteen studies met inclusion criteria for the present meta-analysis. The pooled sensitivity and specificity for diagnosing tuberculous peritonitis were 0.93 (95% CI: 0.89–0.95) and 0.96 (95% CI: 0.94–0.97), respectively. The positive likelihood ratio was 15.80 (95% CI: 10.87–22.95), negative likelihood ratio was 0.09 (95% CI: 0.05–0.16) and diagnostic odds ratio was 249.28 (95% CI: 113.11–549.39). The area under the SROC was 0.98.ConclusionsAscitic ADA determination is a relatively sensitive and specific test for the diagnosis of tuberculous peritonitis. Measurement of ADA in ascites is thus likely to be a useful diagnostic method for tuberculous peritonitis.

Pooled analysis of 163 published tuberculous peritonitis cases from Turkey

“…A metaanalysis indicated that when using a threshold of 39 IU/L, the test had specificity of 97% and sensitivity of 100% (50). According to the results of metaanalyses, a finding of elevated ADA in addition to the patient's clinical presentation may justify the initiation of empiric antitubercular therapy while waiting for culture and biopsy results (50)(51)(52).With the exception of two patients, the ADA level was elevated (using a threshold of 39 IU/L) in all patients in the current study for whom data were available. The assessment of ADA level is simple, fast, and inexpensive, but levels may appear normal due to active cellular immunity in cases of HIV coinfection or cirrhosis.…”

Clinical Aspects of Adult Tuberculosis

“…Tuberculous peritonitis with ascites results in abdominal swelling often accompanied by acute symptoms of fever, anorexia, and weight loss. The final diagnosis is established by investigation of the ascitic fluid, which apart from cytology and mycobacterial smear, molecular diagnostics, and culture, may be tested for adenosine deaminase (Shen et al 2013) and using IGRA (Chou et al 2011). Laparoscopy, open surgical biopsy, or colonoscopy (Sanai and Bzeizi 2005) may need to be performed, and the diagnosis of TB of other abdominal organs is often made following surgical biopsy or tissue sampling guided by ultrasound or CT.…”

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“…This test is considered a marker of peritoneal tuberculosis with acceptable sensitivity and specificity. 10 The detection of CMV in PCR of the ascetic fluid and good response to ganciclovir with rapid resolution of ascites all favored the diagnosis of CMV peritonitis without perforation in this case of CMV colitis after liver transplant. One might consider negative blood PCR and PP65 antigenemia against the diagnosis of CMV disease in this patient, but these laboratory tests in the setting of local manifestations of CMV infection might be negative, especially in CMV-positive recipients, and the negative results should not deviate attention from this infection.…”