title: Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy: a meta-analysis.
abstract: BACKGROUND
  Conventional tests are not always helpful in making a diagnosis of tuberculous pleurisy. Many studies have investigated the usefulness of adenosine deaminase (ADA) in pleural fluid for the early diagnosis of tuberculous pleurisy. We conducted a meta-analysis to determine the accuracy of ADA measurements in the diagnosis of tuberculous pleurisy.
  
  
  METHODS
  After a systematic review of English language studies, sensitivity, specificity, and other measures of accuracy of ADA concentration in the diagnosis of pleural effusion were pooled using random effects models. Summary receiver operating characteristic curves were used to summarize overall test performance.
  
  
  RESULTS
  Sixty-three studies met our inclusion criteria. The summary estimates for ADA in the diagnosis of tuberculous pleurisy in the studies included were sensitivity 0.92 (95% confidence interval 0.90-0.93), specificity 0.90 (95% confidence interval 0.89-0.91), positive likelihood ratio 9.03 (95% confidence interval 7.19-11.35), negative likelihood ratio 0.10 (95% confidence interval 0.07-0.14), and diagnostic odds ratio 110.08 (95% confidence interval 69.96-173.20).
  
  
  CONCLUSIONS
  ADA determination is a relative sensitive and specific test for the diagnosis of tuberculous pleurisy. Measurement of ADA in pleural effusion is thus likely to be a useful diagnostic tool for tuberculous pleurisy. The results of ADA assays should be interpreted in parallel with clinical findings and the results of conventional tests.
authors.affiliation: Institute of Respiratory Diseases, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021 Guangxi, People's Republic of China.
authors.forename: Qiu-Li
authors.initials: QL
authors.lastname: Liang
authors.forename: Huan-Zhong
authors.initials: HZ
authors.lastname: Shi
authors.forename: Ke
authors.initials: K
authors.lastname: Wang
authors.forename: Shou-Ming
authors.initials: SM
authors.lastname: Qin
authors.forename: Xue-Jun
authors.initials: XJ
authors.lastname: Qin
mesh_terms: D000243:Adenosine Deaminase / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis; D004796:Clinical Enzyme Tests; D006801:Humans; D009169:Mycobacterium tuberculosis; D016017:Odds Ratio; D010996:Pleural Effusion / Q000201:enzymology*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014396:Tuberculosis, Pleural / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D000243:Adenosine Deaminase