Adenosine deaminase activity in tuberculous peritonitis among patients with underlying liver cirrhosis.
OBJECTIVE
To investigate the value of adenosine deaminase (ADA) for early detection of tuberculous peritonitis (TBP) among cirrhotic patients.


METHODS
We retrospectively analyzed 22 patients with TBP from July 1990 to June 2010. Twenty-five cirrhotic patients with uninfected ascites were prospectively enrolled as the cirrhosis control group from July 2010 to June 2011. An additional group of 217 patients whose ascites ADA levels were checked in various clinical conditions were reviewed from July 2008 to June 2010 as the validation group.


RESULTS
The mean ascites ADA value of cirrhotic patients with TBP (cirrhotic TBP group, n = 8) was not significantly different from that of non-cirrhotic patients (non-cirrhotic TBP group, n = 14; 58.1 ± 18.8 U/L vs. 70.6 ± 29.8 U/L, P = 0.29), but the mean ascites ADA value of the cirrhotic TBP group was significantly higher than that of the cirrhosis control group (58.1 ± 18.8 U/L vs. 7.0 ± 3.7 U/L, P < 0.001). ADA values were correlated with total protein values (r = 0.909, P < 0.001). Using 27 U/L as the cut-off value of ADA, the sensitivity and specificity were 100% and 93.3%, respectively, for detecting TBP in the validation group.


CONCLUSIONS
Even with lower ADA activity in ascites among cirrhotic patients, ADA values were significantly elevated during TBP, indicating that ADA can still be a valuable diagnostic tool.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan, China.
Yi-Jun
YJ
Liao
Chun-Ying
CY
Wu
Shou-Wu
SW
Lee
Chia-Ling
CL
Lee
Sheng-Shun
SS
Yang
Chi-Sen
CS
Chang
Teng-Yu
TY
Lee
D000243:Adenosine Deaminase / Q000097:blood / Q000378:metabolism*; D000368:Aged; D001201:Ascites / Q000378:metabolism; D001706:Biopsy / Q000379:methods; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005355:Fibrosis; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000201:enzymology*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000097:blood; D014395:Peritonitis, Tuberculous / Q000097:blood / Q000201:enzymology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies
D000243:Adenosine Deaminase