HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (25) Citing Articles via Google Scholar Google Scholar Articles by Riantawan, P. Articles by Rojanaraweewong, P. Search for Related Content PubMed PubMed Citation Articles by Riantawan, P. Articles by Rojanaraweewong, P.

Diagnostic Value of Pleural Fluid Adenosine Deaminase in Tuberculous Pleuritis With Reference to HIV Coinfection and a Bayesian Analysis^*

^* From the Divisions of Medicine (Drs. Riantawan and Chaowalit) and Pathology and Biochemistry (Dr. Wongsangiem and Mr. Rojanaraweewong), Central Chest Hospital, Department of Communicable Disease Control, Ministry of Public Health, Nonthaburi, Thailand.

Correspondence to: Pratheep Riantawan, MSc, MD, Central Chest Hospital, 39 Tiwanon Rd, Nonthaburi, 11000 Thailand

Objectives: To evaluate the diagnostic use of pleural fluid adenosine deaminase (ADAPF) levels in tuberculous pleuritis (TBpl), with a special reference to HIV coinfection and a Bayesian analysis.

Methods: We investigated a total of 216 patients with pleural effusion, including 100 with TBpl, 68 with malignant effusion, 6 with transudates, 19 with empyema, 15 with miscellaneous diseases, and 8 with diseases of unknown etiology.

Results: The mean values (SE) of ADAPF were 110 (4.5) U/L in patients with TBpl vs 28 (5.3) U/L in patients with a malignancy, 18 (5.7) U/L in patients with transudates, 13 (2.1) U/L in patients with diseases of unknown etiology, 22 (5.1) U/L in patients with miscellaneous diseases, and 191 (26.3) U/L in patients with empyema (Kruskal-Wallis test, p < 0.001). The ADAPF level was 110 (4.5) U/L in 37 HIV-positive patients with TBpl vs 114 (4.1) U/L in 52 HIV-negative patients with TBpl (Mann-Whitney U test, p > 0.05). A receiver operating characteristic curve identified the best cutoff at 60 U/L, yielding measures for sensitivity (0.95), specificity (0.96), positive predictive values (PPVs; 0.96), and negative predictive values (0.95). A Bayesian analysis showed a posttest probability of PPV ranging from 0.5 to 0.99, resulting from a pretest probability of 0.05 to 0.9.

Conclusions: ADAPF is diagnostically useful across the various prevalences of TBpl, and its best diagnositic utility is in areas of intermediate prevalence of the disease. Moreover, the diagnostic value of ADAPF is independent of HIV serologic status.

Key Words: adenosine deaminase • Bayesian analysis • human immunodeficiency virus • pleural effusion • pleural fluid • tuberculous pleuritis

This article has been cited by other articles:

				A. Gopi, S. M. Madhavan, S. K. Sharma, and S. A. Sahn Diagnosis and Treatment of Tuberculous Pleural Effusion in 2006 Chest, March 1, 2007; 131(3): 880 - 889. [Abstract] [Full Text] [PDF]

				R. Laniado-Laborin Adenosine Deaminase in the Diagnosis of Tuberculous Pleural Effusion: Is It Really an Ideal Test? A Word of Caution Chest, February 1, 2005; 127(2): 417 - 418. [Full Text] [PDF]

				K. D. Miller, R. Barnette, and R. W. Light Stability of Adenosine Deaminase During Transportation Chest, December 1, 2004; 126(6): 1933 - 1937. [Abstract] [Full Text] [PDF]

				A.H. Diacon, B.W. Van de Wal, C. Wyser, J.P. Smedema, J. Bezuidenhout, C.T. Bolliger, and G. Walzl Diagnostic tools in tuberculous pleurisy: a direct comparative study Eur. Respir. J., October 1, 2003; 22(4): 589 - 591. [Abstract] [Full Text] [PDF]

				Y. P. Kataria and I. Khurshid Adenosine Deaminase in the Diagnosis of Tuberculous Pleural Effusion Chest, August 1, 2001; 120(2): 334 - 336. [Full Text] [PDF]

				Y. C. G. Lee, J. T. Rogers, R. M. Rodriguez, K. D. Miller MD, and R. W. Light Adenosine Deaminase Levels in Nontuberculous Lymphocytic Pleural Effusions Chest, August 1, 2001; 120(2): 356 - 361. [Abstract] [Full Text] [PDF]