title: Adenosine deaminase is a useful biomarker to diagnose pleural tuberculosis in low to medium prevalence settings.
abstract: Adenosine deaminase (ADA) activity measurement in pleural fluid is a relevant test to diagnose pleural tuberculosis (pTB) in high tuberculosis prevalence settings. We investigated the diagnostic utility of pleural ADA using a retrospective analysis of patients admitted with newly diagnosed pleural effusion without identified etiology between 2001 and 2008 in Paris suburb, a low to medium tuberculosis prevalence area. 104 adults (mean age 55 years; 34 with pTB, 70 with other diagnoses) were analyzed. Median follow-up was 15.6 months. Mean [interquartile range] pleural ADA was 119 U/L [IQR: 83-143] in pTB and 24 U/L [IQR: 15-31] in non-tuberculous effusions (P<0.001). With an optimal pleural ADA cut-off value of 41.5 U/L for pTB diagnosis, sensitivity and specificity were 97.1% and 92.9%, while positive and negative predictive values were 86.8% and 98.5%, respectively. We conclude that pleural ADA activity could be integrated in the diagnostic procedures of pTB in low to medium tuberculosis prevalence settings.
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, 94275 Le Kremlin-Bicêtre, France; Université Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Gustave Roussy, Département de Médecine Oncologique, 94805 Villejuif, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Michot
authors.affiliation: Institut Pasteur, Unité d'Epidémiologie des Maladies Emergentes, 75015 Paris, France.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Madec
authors.affiliation: AP-HP, Hôpital Bicêtre, Service de Pneumologie, 94275 Le Kremlin-Bicêtre, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bulifon
authors.affiliation: AP-HP, Hôpital Bicêtre, Service de Pneumologie, 94275 Le Kremlin-Bicêtre, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Thorette-Tcherniak
authors.affiliation: AP-HP, Hôpital Bicêtre, Département de Microbiologie, 94275 Le Kremlin-Bicêtre, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Fortineau
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, 94275 Le Kremlin-Bicêtre, France; Université Paris-Sud, 94275 Le Kremlin-Bicêtre, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noël
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, 94275 Le Kremlin-Bicêtre, France; Université Paris-Sud, 94275 Le Kremlin-Bicêtre, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lambotte
authors.affiliation: Service de Santé des Armées, Hôpital Bégin, Département de Biochimie, 94160 Saint-Mandé, France.
authors.forename: Younes
authors.initials: Y
authors.lastname: El Jahiri
authors.affiliation: Service de Santé des Armées, Hôpital Bégin, Département de Biochimie, 94160 Saint-Mandé, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Delacour
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, 94275 Le Kremlin-Bicêtre, France; Université Paris-Sud, 94275 Le Kremlin-Bicêtre, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Delfraissy
authors.affiliation: Université de Nantes, Inserm UMR 1087/CNRS UMR 6291, 44007 Nantes, France; L'institut du thorax, Service de Pneumologie, Hôpital G. et R. Laënnec, CHU de Nantes, 44093 Nantes cedex 1, France. Electronic address: xavier.blanc@chu-nantes.fr.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Blanc
mesh_terms: D000243:Adenosine Deaminase / Q000378:metabolism*; D000328:Adult; D000368:Aged; D015415:Biomarkers; D004789:Enzyme Activation; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010996:Pleural Effusion / Q000201:enzymology*; D016066:Pleural Effusion, Malignant / Q000201:enzymology; D015995:Prevalence; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D014396:Tuberculosis, Pleural / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism* / Q000382:microbiology
chemical_list: D015415:Biomarkers; D000243:Adenosine Deaminase
keywords: Biological marker; Mycobacterium tuberculosis; Pleural effusion