PT  - JOURNAL ARTICLE
AU  - Jethani, Varuna
AU  - Sindhwani, Girish
AU  - Raghuvanshi, Aarti
AU  - Mehrotra, Vinit
AU  - Khanduri, Rakhee
TI  - Comparison of diagnostic utility of pleural fluid ADA and interferon-gamma release assay (IGRA) in differentiating tubercular and non-tubercular exudative pleural effusion
AID  - 10.1183/13993003.congress-2015.PA1534
DP  - 2015 Sep 01
TA  - European Respiratory Journal
PG  - PA1534
VI  - 46
IP  - suppl 59
4099  - http://erj.ersjournals.com/content/46/suppl_59/PA1534.short
4100  - http://erj.ersjournals.com/content/46/suppl_59/PA1534.full
SO  - Eur Respir J2015 Sep 01; 46
AB  - Background: Tuberculosis is a common cause of pleural effusion, especially in developing countries. ADA and interferon-gamma release assay (IGRA) as diagnostic markers for tuberculosis have been studied but studies with comparative analysis of these markers are scarce especially from developing countries, where burden of tuberculosis is enormous.Aims and objectives: To compare the efficacy of pleural fluid ADA and IGRA to diagnose tubercular pleural effusion and to differentiate between tubercular and non-tubercular exudative pleural effusion.Material and methods: Ninety patients, 45 each with tubercular and non-tubercular etiology, with exudative pleural effusion were included in the study, after informed consent. Pleural fluid of all subjects was tested for ADA and IGRA, along with routine pleural fluid analysis. The sensitivity, specificity, negative and positive predictive values (NPV, PPV) of these markers to diagnose tubercular etiology was calculated. The study bears approval from Institutional Ethics Committee.Results: Sensitivity/specificity/PPV/NPV for ADA (Using a cut off of 40 U/L), IGRA (using a cut off 200 pg/ml) and for combination of these two was 88.89/99.85/86.96/99.87, 97.78/97.78/97.78/97.78 and 99.78/84.78/86.27/97.50 respectively.Conclusion: Pleural fluid ADA and IGRA have comparable efficacy in diagnosing tubercular pleural effusion. Combining ADA and IGRA improves the sensitivity. Although sensitivity and PPV of IGRA were found to be better than ADA, but considering the cost effectiveness of ADA, in resource poor countries, ADA is more suitable for this purpose.