title: Diagnostic accuracy of ascitic fluid IFN-gamma and adenosine deaminase assays in the diagnosis of tuberculous ascites.
abstract: In this study, we evaluated the diagnostic accuracy and cost-effectiveness of ascitic fluid interferon-gamma (IFN-gamma) and adenosine deaminase (ADA) assays in the diagnosis of tuberculous ascites. Ascitic fluid from patients with proven tuberculosis (TB) (n = 31) and non-TB ascites (n = 88) was analyzed for IFN-gamma and ADA levels. Areas under the receiver operative characteristic (ROC) curves (AUCs) for the two biologic markers were compared. Levels of ascitic fluid IFN-gamma, median (range): 560 (104-1600) pg/mL vs. 4.85 (0-320) pg/mL (p < 0.001), and ADA, median (range): 58 (16-331) IU/L vs. 10 (0-59) IU/L (p = 0.001), were significantly different between TB and non-TB groups. IFN-gamma and ADA assays showed equal sensitivity (0.97) and differed marginally in specificity (0.97 vs. 0.94). Difference in AUCs was not significant (0.99 vs. 0.98, p < 0.62). For differentiating TB from non-TB ascites, optimal cutoff points were 112 pg/mL for IFN-gamma and 37 IU/L for ADA. The accuracy of the ADA assay was similar to that of the IFN-gamma assay in differentiating of TB from non-TB ascites. Because both material and human costs of the ADA assay are far less than those of the IFN-gamma assay, the former is probably the most appropriate diagnostic test for analysis of peritoneal fluid in resource- limited settings.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. sksharma@aiims.ac.in
authors.forename: S K
authors.initials: SK
authors.lastname: Sharma
authors.forename: Mohammad
authors.initials: M
authors.lastname: Tahir
authors.forename: Alladi
authors.initials: A
authors.lastname: Mohan
authors.forename: Duncan
authors.initials: D
authors.lastname: Smith-Rohrberg
authors.forename: Hemant K
authors.initials: HK
authors.lastname: Mishra
authors.forename: R M
authors.initials: RM
authors.lastname: Pandey
mesh_terms: D000243:Adenosine Deaminase / Q000032:analysis*; D000328:Adult; D001201:Ascites; D001202:Ascitic Fluid; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D014395:Peritonitis, Tuberculous / Q000175:diagnosis*; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D007371:Interferon-gamma; D000243:Adenosine Deaminase