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October2011,Vol140,No.4_MeetingAbstracts
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PosterPresentations:Wednesday,October26,2011 | October2011

TheUseofDifferentCutoffValuesofADALiquidLevel
inDiagnosisofTuberculousPleurisyinCountriesWith
DifferentIncidenceofTuberculosis FREETOVIEW

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PerlatKapisyzi,PhDDhimitraqArgjiri,MDAnilaAliko,,PhDJetaBeli,,PhDYlliVakeflliu,,MD
RolandKore,MDElenkaShehu,PhDHoltaTafa,MDReginaHasa,MDRichardLight,PhD
AuthorandFundingInformation
Chest.2011140(4_MeetingAbstracts):703A.doi:10.1378/chest.1108296

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Article

Abstract
PURPOSE:TostudytheuseofcutoffvaluesoffluidADAlevelindifferentialdiagnosisof
tuberculouspleurisyincountrywithlowincidenceoftuberculosis.

METHODS:121consecutivepatientswithpleuraleffusionwereprospectivelystudiedThestudy
included82males,39femaleswithameanageof59.317years.Exudativeeffusionswere
classified:malignantpleuraleffusions,39(39.8%),TBpleuraleffusions,39(39.8%),
parapneumonicpleuraleffusions,20(20.4%).Thephotometricmethodwasused

RESULTS:IntuberculousgroupthemeanofADAlevelwas122.453.3UI/L,malignanteffusionit
was59.731.7UI/L(p=0.0001)parapneumoniceffusions9648UI/L.FluidADAin24/39of
malignanteffusionsand18/20parapneumoniceffusionswasabovediagnosticcutoff40UI/Lin
fourof39tuberculouspleurisyADAwasunder40UI/L.MeanADAlevelwasgreaterinpatients<
35yearsold141.946.6UI/L.Nopatientsofage<35yearhadADAlevelunder40UI/L.The
sensitivityofADAinTBeffusionsatcutoff>40U/Lwas89.7%,specificity28.8%,PPV54.5%.
Thecutoffvalueat95UI/LhadthegreatestYOUDENindex(0.488),bestLahr+(3.4),thehighest
specificity,PPV79.6%,and69.2%respectively,sensibility69.2%.

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CONCLUSIONS:IncountrieswithlowincidenceofTBthediagnosticcutoffvalueofADAlevel
havetobedifferentfromcountrieswithhighincidence.ThebestcutoffvalueofpleuralfluidADA
levelindiagnosisofTBwas95UI/L.InmanycasesADAlevelsinnontuberculousexudativepleural
effusionsexceededthecutoffvaluesoftuberculardisease(40UI/L).Adenosinedeaminaselevelof
lessthan40U/Linpatients<35yearsexcludesthetubercularetiologyofexudativepleural
effusion.

CHESTJournalArticles
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PulmonaryChangesofPleuralTB:Upto
DateCTImaging

CLINICALIMPLICATIONS:IndiagnosisofpleuraleffusionsthecutoffvaluesofADApleural
effusionhavetoconsideraccordingtheageofpatientsandincidenceoftuberculosis.

Chest.2014146(6):16041611.
doi:10.1378/chest.140196

DISCLOSURE:Thefollowingauthorshavenothingtodisclose:PerlatKapisyzi,DhimitraqArgjiri,

PleuralTuberculosisintheUnitedStates

AnilaAliko,,JetaBeli,,YlliVakeflliu,,RolandKore,ElenkaShehu,HoltaTafa,ReginaHasa,
RichardLight
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:IncidenceandDrugResistance
Chest.2007131(4):11251132.
doi:10.1378/chest.062352

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Chest.2006129(5):12531258.
doi:10.1378/chest.129.5.1253
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