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Int J Tuberc Lung Dis. 2003 Aug;7(8):777-86.

Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: a meta-analysis.

Author information

1
Divisione Clinicizzata di Malattie Respiratorie, Università di Tor Vergata, Roma, Italy.

Abstract

OBJECTIVE:

As Mycobacterium tuberculosis isolation rates in tuberculous effusions are relatively low, several biochemical and immunological markers have been proposed to diagnose tuberculous pleurisy including adenosine deaminase (ADA) and interferon-gamma (IFN-gamma). Here we summarise the literature on ADA and IFN-gamma as predictors of tuberculous pleurisy.

METHODS:

After a systematic review of English language studies, we used summary receiver operating characteristic curve (SROC) analysis to determine the cumulative diagnostic accuracy of both markers and Bayes' theorem to calculate post-test probability of disease in settings with different prevalences of tuberculous pleurisy, assessed and reported the quality of primary studies.

RESULTS:

From 1978 to November 2000, studies containing sufficient data for the determination of both sensitivity and specificity were 31 on ADA, including 4738 patients, and 13 on IFN-gamma, including 1189 patients. SROC curve yielded a maximum joint sensitivity and specificity of 93% for ADA and 96% for IFN-gamma. In the setting of tuberculous effusion prevalence of 5%, 25% and 85%, post-test probability of a negative ADA test were 0.4%, 2.4% and 24%, and 0.22%, 1.2% and 17% for a negative IFN-gamma test.

CONCLUSION:

With the caveat that limitations in the design of the studies summarised here may distort estimates of test performance, ADA and IFN-gamma appear to be reasonably accurate at detecting TB pleurisy.

PMID:
12921155
[Indexed for MEDLINE]

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