Characteristics of pleural effusion with a high adenosine deaminase level: a case–control study

Abstract

Background Increased pleural fluid adenosine deaminase (ADA) is useful for diagnosing tuberculous pleurisy (TB), but high ADA levels are associated with other diseases. In this study, we compare various disease characteristics in patients with high-ADA pleural effusion. Methods We retrospectively collected data for 456 patients with pleural fluid ADA levels of ≥ 40 U/L from January 2012 to October 2021. Cases were classified as TB (n = 203), pleural infection (n = 112), malignant pleural effusion (n = 63), nontuberculous mycobacteria (n = 22), malignant lymphoma (ML) (n = 18), autoimmune diseases (n = 11), and other diseases (n = 27), and data were compared among those diseases. Predictive factors were identified by comparing data for a target disease to those for all other diseases. A diagnostic flowchart for TB was developed based on those factors. Results The most frequent disease was TB, though 60.0% of patients were diagnosed with other diseases. Median ADA levels in patients with TB were 83.1 U/L (interquartile range [IQR] 67.2–104.1), higher than those of patients with pleural infection (median 60.9 [IQR 45.3–108.0], p = 0.004), malignant pleural effusion (median 54.1 [IQR 44.8–66.7], p < 0.001), or autoimmune diseases (median 48.5 [IQR 45.9–58.2], p = 0.008), with no significant difference from NTM (p = 1.000) or ML (p = 1.000). Pleural fluid lactate dehydrogenase (LDH) levels of < 825 IU/L were beneficial for the diagnosis of TB. Neutrophil predominance or cell degeneration, white blood cell count of ≥ 9200/µL or C-reactive protein levels of ≥ 12 mg/dL helped in diagnosing pleural infection. Pleural fluid amylase levels of ≥ 75 U/L and a pleural fluid ADA/total protein (TP) ratio of < 14 helped in diagnosing malignant pleural effusion. High serum LDH and high serum/pleural fluid eosinophils helped in diagnosing ML and autoimmune diseases, respectively. The flowchart was comprised of the following three factors: pleural fluid LDH < 825 IU/L, pleural fluid ADA/TP of < 14, and neutrophil predominance or cell degeneration, which were decided by a decision tree. The diagnostic accuracy rate, sensitivity, and specificity for the diagnosis of TB were 80.9%, 78.8%, and 82.6%, respectively. Conclusion Cases involving high pleural fluid ADA levels should be investigated using several factors to distinguish TB from other diseases.

Differences in Pleural Fluid Amylase Levels in Patients with Malignant Pleural Effusion Based on Cancer Type, Histologic Type, and Epidermal Growth Factor Receptor Mutations

“…The cut-off value of pleural amylase level was determined to be ! 75 IU/L in reference to a previous report (6). Furthermore, pleural amylase levels of !…”

“…Other cut-off values of pleural amylase levels for distinguishing malignant pleural effusion from other diseases have been reported as ! 75 IU/L (6) or ! 67 IU/L (7).…”

Clinical predictive model for identifying high-risk factors in Pleurisy Tuberculoma patients

“…ADA, an enzyme found throughout human tissues and body uids, is secreted by activated lymphocytes, macrophages, and neutrophils. It serves as a general indicator of in ammation, being present in lymphocyte-based exudates and recognized as a sign of cell-mediated immune reactions [23]. A high ADA index is regarded as a key element in the diagnostic criteria for tuberculous pleurisy [24].…”

Expert Review on Contemporary Management of Common Benign Pleural Effusions

“…55 Frequently, the blood peripheral leukocyte count is normal (>70%) and levels of serum C-reactive protein do not exceed 120 mg/dL. [55][56][57] PEs are typically unilateral (95%), loculated in half the cases, and small to moderate in size (i.e., they occupy <50% of the hemithorax) in more than 60%. 55 Associated parenchymal infiltrates are seen in 30% of chest radiographs (►Fig.…”