PT  - JOURNAL ARTICLE
AU  - D. Jiménez Castro
AU  - G. Díaz Nuevo
AU  - E. Pérez-Rodríguez
AU  - R.W. Light
TI  - Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions
AID  - 10.1183/09031936.03.00051603
DP  - 2003 Feb 01
TA  - European Respiratory Journal
PG  - 220--224
VI  - 21
IP  - 2
4099  - http://erj.ersjournals.com/content/21/2/220.short
4100  - http://erj.ersjournals.com/content/21/2/220.full
SO  - Eur Respir J2003 Feb 01; 21
AB  - Adenosine deaminase (ADA) can aid in the diagnosis of tuberculous pleural effusions, but false-positive findings from lymphocytic effusions have been reported. The purpose of this study is to assess the ADA levels in nontuberculous lymphocytic pleural effusions (lymphocyte count >50%) of different aetiologies. Altogether, 410 nontuberculous lymphocytic pleural fluid samples were consecutively selected. These included malignant effusions (n=221), idiopathic effusions (n=76), parapneumonic effusions (n=35), postcoronary artery bypass graft surgery effusions (n=6), miscellaneous exudative effusions (n=21) and transudative effusions (n=51). The ADA level reached the diagnostic cut-off for tuberculosis (40 U·L−1) in seven of the 410 cases (1.71%). The negative predictive value of ADA for the diagnosis of pleural tuberculosis was 99% (403 of 407 cases) in the group of lymphocytic pleural effusions. In five of these seven patients ADA1 and ADA2 were measured, and in all these cases (100%) ADA1/ADAp correctly classified these lymphocytic effusions as nontuberculous (ratio <0.42). This prospective study provides additional evidence that adenosine deaminase levels in nontuberculous lymphocytic pleural effusions seldom exceed the cut-off set for tuberculous effusions. The pleural fluid adenosine deaminase levels were significantly higher in different types of exudative effusions than in transudates. An adenosine deaminase level <40 IU·L−1 virtually excluded a diagnosis of tuberculosis in lymphocytic pleural effusions. Adenosine deaminase1/adenosine deaminasep correctly classified all nontuberculous lymphocytic pleural effusions with high adenosine deaminase levels.