Diagnostic significance of ascites adenosine deaminase levels in suspected tuberculous peritonitis in adults

Abstract

Objectives: There are contradictory reports about the use of adenosine deaminase (ADA) as a diagnostic marker in tuberculous peritonitis patients. Reports evaluating significance of ADA activity in the diagnosis of tuberculous peritonitis in adults are lacking in Nepal. We thus set out to investigate the ascitic fluid ADA levels in suspected tuberculous peritonitis patients and to determine the diagnostic significance of the test statistically. Materials and Methods: This study population comprised of two different adult patients groups. Group I - 35 suspected cases of tuberculous peritonitis and Group II - 35 cases of transudative ascites - the control group (patients with biochemically proved transudates or hypoproteinaemia) and peritoneal tap was done. ADA estimation was carried out by spectrophotometry. Results: ADA levels (Mean &plusmn; SD) in suspected tuberculous peritonitis and transudative ascites cases were 48.5 &plusmn; 17.9 U/L and 19.8 &plusmn; 7.7 U/L respectively (P<0.001). In the receiver operating characteristic (ROC) curve for ascites, ADA cut-off level of 41.5 U/L was found to yield the best results of differential diagnosis; sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the test in tuberculous peritonitis cases were 80.0%, 97.2 %, 96.6%, 82.9%, 88.6% respectively. Conclusion: ADA levels are elevated in suspected tuberculous peritonitis cases and it is a simple, rapid, inexpensive and the least invasive test. It is thus a useful biochemical marker for the early diagnosis of tuberculous peritonitis while waiting for the results of mycobacterial cultures or biopsies.

Keywords

• adenosine deaminase, sensitivity, specificity, diagnostic significance, tuberculous peritonitis

Diagnostic significance of ascites adenosine deaminase levels in suspected tuberculous peritonitis in adults

Öz

Amaç: Tüberküloz peritonit hastalarında adenozin deaminaz’ın (ADA) tanısal belirteç olarak kullanımı hakkında çelişkili raporlar vardır. Nepal’de erişkinlerde tüberküloz peritonit tanısında ADA aktivitesinin değerini araştıran bir çalışma bulunmamaktadır. Bu nedenle şüpheli tüberküloz peritonit hastalarında asit sıvıda ADA düzeylerini araştırmak ve istatistiksel olarak bu testin tanısal önemini belirlemek için yola çıktık.Yöntemler: Çalışmaya alınan hastalar iki farklı erişkin hasta grubundan oluşmaktaydı. Grup I; 35 şüpheli tüberküloz peritonit olgusu, ve Grup II; transüdatif asitli 35 hastanın oluşturduğu kontrol grubu (transüda olduğu biyokimyasal olarak kanıtlanmış veya hipoproteinemisi olan hastalar) çalışmaya dahil edildi ve periton sıvıları alındı. ADA ölçümü spektrofotometri ile yapıldı.Bulgular: ADA düzeyleri (ortalama ± SS)şüpheli tüberküloz peritonit ve transudatif asit olgularında, sırasıyla, 48,5 ± 17,9 U/L ve 19,8 ± 7,7 U/L idi (P<0,001). Asit değerleri için “alıcı işletim karakteristik” (ROC) eğrisinde, ADA kesme seviyesi 41,5 U/L alındığında en iyi ayırıcı tanı değerleri bulundu ve tüberküloz peritonit olgularında testin duyarlılık, özgüllük, pozitif prediktif değer, negatif prediktif değer ve doğruluk düzeyleri, sırasıyla, % 80,0,% 97,2,% 96,6,% 82,9,% 88,6 idi.Sonuç: Şüpheli tüberküloz peritonit olgularında ADA düzeyleri yükselmektedir ve bu basit, hızlı, ucuz ve en az invaziv testtir. Mikobakteri kültürleri veya biyopsi sonuçlarını beklerken tüberküloz peritonit erken tanısı için bu en kullanışlı bir biyokimyasal belirteçtir

Anahtar Kelimeler

• adenozin deaminaz, duyarlılık, özgüllük, tanısal değer; peritonit tüberküloz

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