Diagnostic Accuracy of Pleural Fluid Adenosine Deaminase for Diagnosing Tuberculosis. Meta-analysis of Spanish Studies

Palma, Rosa; Bielsa, Silvia; Esquerda, Aureli; Martínez-Alonso, Montserrat; Porcel, José M.

doi:10.1016/j.arbr.2018.11.007

Cited by 27 publications

(20 citation statements)

References 29 publications

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“… * Information from references 4 , 10 , 12 , 25 , 28 , 31 , 38 , 40 , 44 , 52 and 53 . $ For labeling mesothelioma.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis of 16 Spanish studies, totaling 4147 patients, showed that PF ADA had 93% sensitivity, 92% specificity, LR positive of 12, LR negative of 0.08, and AUC of 0.968 for identifying TB effusions. 28 The high diagnostic accuracy of ADA was independent of the technique used for its measurement, whether colorimetric Giusti, manual or automated kinetic methods. The commonly accepted ADA diagnostic cutoff is >35 U/l.…”

Section: Biomarkers Of Pleural Tuberculosismentioning

confidence: 99%

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Biomarkers in the diagnosis of pleural diseases: a 2018 update

Porcel

2018

Ther Adv Respir Dis

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The use of biomarkers on pleural fluid (PF) specimens may assist the decision-making process and enhance clinical diagnostic pathways. Three paradigmatic examples are heart failure, tuberculosis and, particularly, malignancy. An elevated PF concentration of the amino-terminal fragment of probrain natriuretic peptide (>1500 pg/ml) is a hallmark of acute decompensated heart failure. Adenosine deaminase, interferon-γ and interleukin-27 are three valuable biomarkers for diagnosing tuberculous pleurisy, yet only the first has been firmly established in clinical practice. Diagnostic PF biomarkers for malignancy can be classified as soluble-protein based, immunocytochemical and nucleic-acid based. Soluble markers (e.g. carcinoembryonic antigen (CEA), carbohydrate antigen 15–3, mesothelin) are only indicative of cancer, but not confirmatory. Immunocytochemical studies on PF cell blocks allow: (a) to distinguish mesothelioma from reactive mesothelial proliferations (e.g. loss of BAP1 nuclear expression, complemented by the demonstration of p16 deletion using fluorescence in situ hybridization, indicate mesothelioma); (b) to separate mesothelioma from adenocarcinoma (e.g. calretinin, CK 5/6, WT-1 and D2-40 are markers of mesothelioma, whereas CEA, EPCAM, TTF-1, napsin A, and claudin 4 are markers of carcinoma); and (c) to reveal tumor origin in pleural metastases of an unknown primary site (e.g. TTF-1 and napsin A for lung adenocarcinoma, p40 for squamous lung cancer, GATA3 and mammaglobin for breast cancer, or synaptophysin and chromogranin A for neuroendocrine tumors). Finally, PF may provide an adequate sample for analysis of molecular markers to guide patients with non-small cell lung cancer to appropriate targeted therapies. Molecular testing must include, at least, mutations of epidermal growth-factor receptor and BRAF V600E, translocations of rat osteosarcoma and anaplastic lymphoma kinase, and expression of programmed death ligand 1.

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“… * Information from references 4 , 10 , 12 , 25 , 28 , 31 , 38 , 40 , 44 , 52 and 53 . $ For labeling mesothelioma.…”

Section: Discussionmentioning

confidence: 99%

Section: Biomarkers Of Pleural Tuberculosismentioning

confidence: 99%

Biomarkers in the diagnosis of pleural diseases: a 2018 update

Porcel

2018

Ther Adv Respir Dis

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“…4,5 As a nonspecific indicator of cellular immunity, altered ADA activity has been detected in many diseases, including tuberculosis, rheumatoid arthritis, systemic lupus erythematosus, and liver diseases. 6–8…”

Section: Introductionmentioning

confidence: 99%

Serum adenosine deaminase activity and coronary artery disease: a retrospective case-control study based on 9929 participants

Xuan

Tian

Zhang

et al. 2019

Therapeutic Advances in Chronic Disease

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Background: Adenosine deaminase (ADA) regulates purine metabolism through the conversion of adenosine to uric acid (UA). Adenosine and UA are closely associated with cardiovascular events, but the correlation between serum ADA activity and coronary artery disease (CAD) has not been defined. Methods: We performed a hospital-based retrospective case-control study that included a total of 5212 patients with CAD and 4717 sex- and age-matched controls. The serum activity of ADA was determined by peroxidase assays in an automatic biochemistry analyzer. Results: Serum ADA activity in the CAD group (10.08 ± 3.57 U/l) was significantly lower than that of the control group (11.71 ± 4.20 U/l, p < 0.001). After adjusting for conventional factors, serum ADA activity negatively correlated with the presence of CAD (odds ratio = 0.852, 95% confidence interval: 0.839–0.865, p < 0.001). Among the patients with CAD, serum ADA activity was lowest in patients with myocardial infarction (MI; 9.77 ± 3.80 U/l). Diabetes mellitus and hypertension increased the serum ADA activity in CAD patients. Conclusions: Serum ADA activity is significantly attenuated in patients with CAD, particularly in MI. We propose a mechanism by which the body maintains adenosine levels to protect the cardiovascular system in the event of CAD.

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“…The data from a total of 86 studies eligible for evaluation, including 5 studies from Turkey [13][14][15][16][17] were evaluated in five different meta-analyses. 11,[18][19][20][21] All of these meta-analyses showed that PE ADA activity had a high value diagnostically. A recent meta-analysis of 16 Spanish studies, totaling 4,147 patients, showed that PE ADA had 93% sensitivity, 92% specificity, positive likelihood ratio (LR) of 12, negative LR of 0.08, and area under the curve (AUC) of 0.968 for identifying TPE.…”

Section: Adenosine Deaminasementioning

confidence: 99%

“…The ADA cutoff point for the diagnosis of TPE most widely used was 40 U/L. 21 There is large increase (positive LR: 12) in the probability of TPE with an ADA >40 U/L and large increase (negative LR: 0.08) in the probability of non-TPE (another cause of exudative PE) with an ADA <40 U/L. In other words, an ADA >40 U/L is a high diagnostic accuracy for identifying TPE.…”

Section: Adenosine Deaminasementioning

confidence: 99%

New Biomarkers Used in the Diagnosis of Tuberculosis-Related Pleural Effusions

Teke

2020

J Pediatr Infect Dis

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Tuberculosis-related pleural effusion (TPE) is reported in 12 to 38% of thoracic tuberculosis (TB) cases in the pediatric population. In TPE, the pleural fluid bacilli load is very low, generally resulting in negative acid-fast bacill (AFB) staining and Mycobacterium culture. In the pleural fluid, AFB stain positivity is reported in <20%, and Mycobacterium tuberculosis positive culture in 18 to 38%. In childhood, this ratio is even lower. Also, pleural effusion (PE) mycobacterial culture gives late results (2–8 weeks). Therefore, TPE is diagnosed with pleura biopsy and pleural liquid examination. However, pleura biopsy is a more invasive operation and the diagnosis rates vary. The clinical and laboratory findings are not typical; it is very hard to distinguish between TPE and another cause of exudative PE. This situation makes it essential for research on reliable new biomarkers that can provide fast and accurate diagnosis of TPE. Adenosine deaminase (ADA) activity being above 40 to 50 U/L (despite varying depending on age) strongly suggests TPE. Other new biomarkers featured in TPE diagnosis are interferon-γ, cytokines, and nucleic acid multiplication tests. However, the results of ADA and other potential biomarkers shown to be beneficial in TPE diagnosis should always be interpreted with clinical and microbiological findings because no biomarker can provide information about M. tuberculosis culture and drug resistance. Especially in countries with high resistance against TB drugs, performing pleura biopsy, culture and drug resistance tests are important with regard to diagnosis and therapy planning.

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Diagnostic Accuracy of Pleural Fluid Adenosine Deaminase for Diagnosing Tuberculosis. Meta-analysis of Spanish Studies

Cited by 27 publications

References 29 publications

Biomarkers in the diagnosis of pleural diseases: a 2018 update

Biomarkers in the diagnosis of pleural diseases: a 2018 update

Serum adenosine deaminase activity and coronary artery disease: a retrospective case-control study based on 9929 participants

New Biomarkers Used in the Diagnosis of Tuberculosis-Related Pleural Effusions

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