Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
John, N.
VALUE OF ADENOSIN DEAMINASE ACTIVITY (ADA) IN THE DIAGNOSIS OF INFECTIOUS NON-TUBERCULOUS PLEURAL EFFUSIONS WITH SPECIAL REGARDS TO COMPLICATED
PARAPNEUMONIC EFFUSIONS INCLUDING EMPYEMA
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2016. pp. 92
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Flick Holger
- Hönigl Martin
- Raggam Reinhard Bernd
- Altmetrics:
- Abstract:
- 1.1 Introduction Pneumonia is a very common disease affecting 5 to 11 per 1000 citizens per year in western countries. It is estimated that up to 57% of these patients develop pleural effusion. If antibiotic treatment is delayed a significant portion of these so called simple parapneumonic effusions (PPE) will progress into complicated parapneumonic effusions (CPE) including empyema (E). Adenosine Deaminase Activity (ADA)is a pleural fluid marker that is routinely used in the diagnosis of tuberculous pleurisy. It is highly effective in high and low prevalence tuberculosis settings. However, ADA is also known to be elevated in exudative effusions caused by non-tuberculous diseases like CPE including E.The purpose of the study was to evaluate the benefit of ADA measurement for the detection of these non-tuberculous diseases in a TB low prevalence setting with special regards to CPE including E. To date complex algorithms and various pleural markers are needed to calculate risk of CPE/E. We proclaimed ADA to be an effective and reliable test that can improve current clinical algorithms. 1.2 METHODS We retrospectively reviewed data from 400 patients with undiagnosed pleural effusion that underwent thoracentesis and subsequent ADA analysis between 30th November and 1th May 2015. ADA measurement was performed using the automated,standardized-turbidimetric ADA-analysis on the Cobas 8000 system at the Medical University of Graz. The cause of the pleural effusion was established by reviewing results of the patients’ conventional pleural fluid analysis, microbiologic results and medical files by a consultant pulmonologist. 1.3 RESULTS Etiologies of pleural effusions included malignancy (118 of 400 cases), PPE (83 of 400 cases), CPE/E (19 of 400 cases), E (15 of 400 cases), PAE (10 of 400 cases),tuberculosis (14 of 400 cases), cardiac decompensation (90 of 400 cases) and 37 cases of chronic pleural effusion of unknown etiology. Highest ADA values were found in lymphoma, CPE including empyema, and tuberculosis. Mean ADA values were 100 U/l, 98 U/l, 26 U/l and 38 U/l respectively. In comparison, mean ADA values in patients suffering from cardiac decompensation and malignancy were 4.6 U/l and 9.3 U/l respectively. After examination of all currently used pleural fluid markers we concluded that ADA, LDH and neutrophil share are the most accurate laboratory values to diagnose non-TB pleural infection. In order to evaluate the diagnostic value of ADA we used ROC-analysis for the detection of CPE/E. We found that using a cut off level of 13 U/l yielded the most promising results. Sensitivity, specificity, PPV and NPV were 100%, 77%, 18% and 100% respectively. In addition we found that pleural pH and glucose, which currently used in most clinical algorithms for risk stratification of CPE/E,are far less reliable than supposed. Best sensitivity and specificity for the diagnosis of CPE/E were found in pleural effusions that were negative for malignant cells if ADA, neutrophil share and LDH were combined. Using these pleural markers in conjunction we found sensitivity, specificity,PPV and NPV for CPE/E of 88%, 98%, 68% and 99%. 1.4 Conclusion After evaluation of all currently used pleural markers in pleural effusion we found that ADA, neurophil share and ADA in pleural effusions that were negative for malignant cells, may be more precise in the diagnostic of CPE/E than currently used pleural fluid markers including glucose and pleural pH. Using these pleural markers we found sensitivity, specificity, PPV and NPV for CPE/E of 88%, 98%, 68% and 99% respectively. We compared our proposed algorithm with currently used algorithms and found overall higher sensitivity, specificity and PPV for the new developed one. Therefore we recommend a prospective study in order to substantiate the benefit of ADA determination in clinical practice.