Performance of adenosine deaminase in detecting paediatric pleural tuberculosis: a systematic review and meta-analysis

Abstract

Background Paediatric pleural tuberculosis (TB) is a paucibacillary disease, which increases the difficulty of examination. We aimed to assess the performance of pleural fluid adenosine deaminase (ADA) in the detection of paediatric pleural TB. Methods PubMed, Web of Science Core Collection, Embase and Cochrane Library databases were searched up to 20 December 2021. We used the bivariate and hierarchical summary receiver operating characteristic models to compute pooled estimates for the overall diagnostic accuracy parameters of ADA for diagnosing paediatric pleural TB. Results Eight studies, including 290 pleural fluid samples, met the inclusion criteria. The pooled sensitivity of ADA was 0.85 (95% CI: 0.78–0.90, I 2 : 55.63% < 75%) for detecting patients with paediatric pleural TB. A total of 262 pleural fluid samples from four studies were included to differentiate patients with paediatric pleural TB from controls. At a unified cut-off value of 40 U/L, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the summary receiver operating characteristic curve of ADA were 0.89, 0.58, 2.09, 0.20, 10.48 and 0.89, respectively. Conclusions At a cut-off value of 40 U/L, the overall performance of ADA was good for detecting paediatric pleural TB, with relatively high sensitivity and low specificity. Key message Accurate identification of paediatric pleural TB will help eliminate TB in children. At a cut-off value of 40 U/L, the overall performance of ADA was good for detecting paediatric pleural TB, with relatively high sensitivity and low specificity.

Adenosine deaminase from the cerebrospinal fluid for the diagnosis of tuberculous meningitis: A meta‐analysis

“…In tuberculosis, the amount of ADA appears to be related to the number of activated T lymphocytes responding to tuberculous antigens [68]. Besides the diagnostic role of serum ADA for patients with pulmonary TB, there has been increasing evidence that supports the importance of role of non-blood ADA for the diagnosis of patients with nonpulmonary TB, such as pleural ADA for pleural TB [69,70] and ascites ADA for abdominal TB [71]. Our study further expands the role of non-blood ADA for the diagnosis of non-pulmonary TB by showing the efficacy of ADA from CSF for the diagnosis of TBM.…”

ADA as main biochemical marker in patients with tuberculous effusion

“…In 2019, Aggarwal et al [15] updated the sensitivity (0.92) and specificity (0.90) of ADA with conclusion as good biomarker for detecting pleural TB among adults, including 174 publications. Systematic review and meta-analysis also showed that ADA is good for detecting pediatric TP [16] .…”

Extrapulmonale Tuberkulose

“…In der Pleuraflüssigkeit zeigt sich häufig ein Exsudat mit lymphozytärer Pleozytose und normalem oder moderat erniedrigtem pH-Wert [5]. Zudem kann die Durchführung eines Interferon-Gamma-Release-Assays (IGRA) oder die Bestimmung der Adenosin-Desaminase aus dem Pleuraerguss diagnostische Hinweise geben [6,7]. Gesichert werden kann die Diagnose prinzipiell durch den Nachweis des Mycobacteriums tuberculosis im Pleurapunktat, wobei die Sensitivität von Mikroskopie, PCR und Kultur recht niedrig ist [8].…”