COMPARING THE EFFICACY OF ADA AND PCR IN DIAGNOSING TUBERCULOSIS IN PLEURAL EFFUSION
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2017, Vol 4, Issue 43
Abstract
BACKGROUND Pleural effusion due to TB is currently the most common location for extrapulmonary TB and cases of pleural TB can be expected to increase with the increasing incidence of TB Worldwide. Historically, pleural biopsy was found to be more sensitive in diagnosing TB in pleural effusion as it is more invasive and hazardous than thoracocentesis, alternative diagnostic approaches have been extensively evaluated. Adenosine Deaminase (ADA) has been developed and widely used for the diagnosis of TB due to its simplicity. The aim of the study is to assess and compare the validity of ADA and PCR by calculating the sensitivity and specificity in diagnosing tuberculosis among the patients with pleural effusion. MATERIALS AND METHODS A cross-sectional study was undertaken at our hospital for a period of 2 years between January 2014 to January 2016. 124 patients were admitted during that period and after getting the informed consent signed by the study population. They were included in our study. ADA activity was measured by the standard method as suggested by Guisti. Two mL of pleural fluid was collected in sterile container and was either immediately analysed or refrigerated at 4°C and analysed within 2 days. An ADA value >40 U/L was taken as the cutoff for calculating sensitivity and specificity. Polymerase chain reaction for M. tuberculosis 65 kDa gene was performed on pleural fluid specimens as previously described. The data were entered and analysed by using SPSS version 20. RESULTS Among 124 patients, 97 patients had been confirmed TB. So far, our analysis, we took 97 patients in which 79 were confirmed TB through HPE, 17 through pleural fluid culture and one patient was diagnosed by pleural fluid AFB smear. In our study, the ADA cutoff was assigned as 40 IU/L. The mean ADA levels among the patients with TB pleural effusion were found to be 53.5 IU/L. The sensitivity was 94%, whereas the specificity and the positive predictive value was found to be 100% and the negative predictive value was 82%. The sensitivity of ADA in diagnosing TB in pleural effusion was much higher than the sensitivity of HPE and PCR and the difference was found to be statistically significant, whereas identifying the true negatives (specificity) was almost similar in HPE and ADA and it was 92.5% in PCR, but the difference was not statistically significant and a similar pattern of results was also seen with positive predictive value. Negative predictive value was higher in ADA when compared to HPE and PCR and the difference was found to be statistically significant. CONCLUSION Adding ADA to the pleural fluid workup in high prevalence areas could reduce costs, morbidity and time to diagnosis. According to the current study results, PCR still need refinement before they significantly add to the evaluation of pleural diseases.
Authors and Affiliations
Prasanna Kumar T, Gayathri Devi H. J, Yashwanth T. L, Shankar R
Keywords
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- EP ID EP219924
- DOI 10.18410/jebmh/2017/520
- Views 90
- Downloads 0
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