Adenosine deaminase for diagnosis of tuberculous pleural effusion: A systematic review and meta-analysis

Objective Pleural fluid adenosine deaminase (ADA) is a useful diagnostic test for tuberculous pleural effusion (TPE), but its exact threshold and accuracy in clinical decision-making is unclear. We aimed to assess diagnostic performance of ADA in TPE and to clarify its optimal diagnostic threshold. Methods We searched PubMed, Embase, and Cochrane Library databases for articles indexed up to October 2018. We included English language studies that provided both sensitivity and specificity of ADA in TPE diagnosis. Summary estimates for sensitivity and specificity were obtained through bivariate random effects model, both overall and at prespecified threshold ranges of <36, 40±4, 45–65 and >65 IU/L. Results We retrieved 2162 citations, and included 174 publications with 27009 patients. All studies showed high risk of bias. Summary sensitivity, specificity and diagnostic odds ratio estimates were 0.92 (95% CI 0.90–0.93), 0.90 (95% CI 0.88–0.91) and 97.42 (95% CI 74.90–126.72) respectively. 65 studies with ADA threshold of 40±4 IU/L showed summary sensitivity and specificity of 0.93 (95% CI 0.90–0.95) and 0.90 (95% CI 0.87–0.91) respectively. Four studies with ADA threshold >65 IU/L showed summary sensitivity and specificity of 0.86 (95% CI 0.61–0.96) and 0.94 (95% CI 0.80–0.99) respectively. Conclusion ADA levels in pleural fluid show good diagnostic accuracy in diagnosis of TPE; however, all included studies showed high risk of bias. It was not possible to derive any firm inference on relative clinical utility of different diagnostic thresholds.

• Publication year

  2019

• Venue

  PLoS ONE

• Publication date

  2019-03-26

• Fields of study

  Medicine

• Identifiers
  DOI 10.1371/journal.pone.0213728PMID 30913213PMCID 6435228
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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