ABSTRACT
Background: Pulmonary tuberculosis is the most frequent cause of death by an infectious agent worldwide. Among the extra pulmonary presentations after tuberculous lymphadenitis, pleural TB is the second most frequent Failure to diagnose and treat pleural TB can result in progressive disease with the involvement of other organs in as many as 65% of patients. Conventional methods have proven to be insufficient for diagnosis of pleural TB. Hence, this study was aimed to determine whether combined use of pleural fluid lymphocyte neutrophil ratio and ADA activity would provide a more efficient means for diagnosing tuberculous pleurisy than the use of ADA levels. Aim: To determine whether the combined use of ADA activity and lymphocyte/neutrophil ratio would provide a more efficient means for diagnosing tuberculous pleural effusion than with the use of ADA alone. Materials and methods: Present study was hospital based prospective observational study carried out from February 2016 to July 2016. All the patients with pleural effusion admitted in medical ward at GRH Madurai. Information collected through preformed and pretested proforma. The qualifying patients were undergoing detail history, clinical examination and investigation. Patients were classified as exudative and transudative pleural effusion based on light’s criteria Patients with MRS score of 5 and 6 were declared as very poor outcome and MRS of 3 and 4 as poor outcome. Patients Ramasamy Suresh, Victor Theophilus Premkumar. To study the combined use of pleural fluid lymphocyte/ neutrophil ratio and ADA for the diagnosis of tuberculous pleural effusion. IAIM, 2017; 4(9): 1-5. Page 2 with MRS 0, and 1 were considered as good outcome. Statistical analysis was done by One way ANOVA, Pearson correlation and Chi square test. Results: There was significant correlation between the combined use of ADA along with L/N ratio than ADA alone for diagnosing tuberculous Pleural effusion. Conclusions: The combined use of ADA along with L/N ratio would provide a more efficient means for diagnosing tuberculous Pleural effusion than the use of ADA alone.
ABSTRACT
BACKGROUND: The measurement of adenosine deaminase(ADA) level in pleural fluid is useful in the diagnosis of tuberculous(TB) pleural effusion. However, ADA is also elevated in other diseases such as malignancy, bacterial infections, empyema, and collagen vascular disease, ADA alone has limited value. The object of this study is to determine diagnostic usefulness of the combined use of ADA value with lymphocyte/neutrophil ratio(L/N ratio) rather than the use of ADA alone. METHOD: We evaluated 198 patients(age=55.9+/-12.9, M/F=2.7:1) with pleural effusion who had admitted in Gyeong-sang National University Hospital from Jan. 1999 to Dec. 2001. retrospectively. Patients were divided into four diagnostic groups: TB pleural effusion(n=91), parapneumonic effusion(n=65), malignant effusion(n=21), and transudative effusion(n=13). The ADA level, differential cell count, biochemistry, cytology, and microbiology of each diagnostic groups were evaluated. The sensitivity, specificity, negative predictive value(npv), positive predictive value(ppv) and efficiency were calculated at each ADA values and combined ADA value with various L/N ratios. RESULT: The ADA level in TB pleural effusion was significantly higher than that of parapneumonic effusion, malignant pleural effusion, and transudative effusion(por=50 IU/L in the diagnosis of TB pleural effusion were 89.0%, 82.2%, 81.0%, 89.8% and 85.5% respectively. When ADA>or=50 IU/L was combined with lymphocyte/neutrophil ratio>or=0.75, sensitivity, specificity, ppv, npv, and efficiency were 83.5%, 96.3%, 95.0%, 87.9% and 90.5% respectively. Specificity, ppv and efficiency were increased with combination of ADA value and L/N ratio. CONCLUSION: Combination of ADA value and L/N ratio in pleural effusion is more useful than ADA value alone in the diagnosis of TB pleural effusion.