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Diagnostic value of adenosine deaminase in nontuberculous lymphocytic pleural effusions

¹ Emergency Dept and ² Respiratory Dept, Ramón y Cajal Hospital, Madrid, Spain. ³ Pulmonary Division, Saint Thomas Hospital and Vanderbilt University, Nashville, TN, USA

CORRESPONDENCE: D. Jiménez Castro, Emergency Dept, Ramón y Cajal Hospital, 28034, Madrid, Spain. Fax: 34 949227502. E-mail: djc_69_98@yahoo.com

Keywords: adenosine deaminase, pleural effusion, tuberculosis

Received: June 19, 2002
Accepted September 23, 2002

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/ADA_p 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 deaminase_p correctly classified all nontuberculous lymphocytic pleural effusions with high adenosine deaminase levels.

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