Usefulness of Pleural Adenosine Deaminase in Children for the Differentiation Tuberculous Pleural Effusion from Mycoplasma pneumonia with Pleural Effusion

Jae-Hyung Choi; Won-Kyung Hur; Hey-Sung Baek; Jae-Won Oh; Ha-Baik Lee

doi:10.7581/pard.2012.22.4.404

Journal List > Pediatr Allergy Respir Dis > v.22(4) > 1033202

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Choi, Hur, Baek, Oh, and Lee: Usefulness of Pleural Adenosine Deaminase in Children for the Differentiation Tuberculous Pleural Effusion from Mycoplasma pneumonia with Pleural Effusion

Original Article

Pediatric Allergy and Respiratory Disease

Pediatric Allergy and Respiratory Disease 2012; 22(4): 404-410.

Published online: 31 December 2012

DOI: https://doi.org/10.7581/pard.2012.22.4.404

Usefulness of Pleural Adenosine Deaminase in Children for the Differentiation Tuberculous Pleural Effusion from Mycoplasma pneumonia with Pleural Effusion

Jae-Hyung Choi, MD¹, Won-Kyung Hur, MD², Hey-Sung Baek, MD, PhD², Jae-Won Oh, MD, PhD¹, Ha-Baik Lee, MD, PhD¹

¹Department of Pediatrics, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea.

²Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

Corresponding author (hablee@hanyang.ac.kr)

Received 5 August 2012 Revised 23 August 2012 Accepted 7 October 2012

Abstract

Purpose

Determination of adenosine deaminase (ADA) in pleural fluid has been suggested as another tool to establish early diagnosis of tuberculous pleural effusion. However, there are few studies concerning its usefulness in children. The objective of this study was to evaluate the utility of the determination of ADA level in pleural fluid for the differential diagnosis between tuberculous pleural effusion (TPE) and Mycoplasma pneumonia with pleural effusion (MP) in children.

Methods

We retrospectively reviewed the clinical records of 13 TPE patients and 21 MP patients with pleural effusion. Also, we analyzed ADA levels, and clinical, biochemical, microbiologic and cytologic findings in the pleural fluid.

Results

The pleural fluid of all the subjects revealed exudative rather than transudate characteristics. The mean ADA level in the TPE group was significantly higher than that in the MP group (106.27±43.71 IU/L vs. 65.28±26.27 IU/L, P=0.003). The area under the curve in receiver operating characteristic analysis was 0.810. With a cut-off level for ADA of 60 U/L, the sensitivity, specificity, positive predictive value, and negative predictive value were 92.3%, 61.9%, 60.0%, and 92.9%, respectively. As many as 38.9% of patients with MP were false-positive with this ADA cut-off setting.

Conclusion

Although the measurement of ADA activity in pleural fluid can help TPE diagnosis, we should consider that some cases of MP with pleural effusion showed high ADA activities. Accordingly, the utility of the ADA level in pleural fluid for the differentiation of TPE from MP declines and additional relevant studies are required.

Keywords: Adenosine deaminase, Tuberculous pleural effusion, Mycoplasma pneumoniae pneumonia, Child

Figures and Tables

Fig. 1

Pleural adenosine deaminaselevels in tuberculous pleural effusion (TPE) patients group (n=13) and Mycoplasma pneumoniae pneumonia (MP) group (n=21). The horizontal lines in the dot plots represent mean and standard deviation. ADA, adenosine deaminase.

Fig. 2

Receiver operating characteristic curve for pleural fluid adenosine deaminase (ADA) levels diagnosing tuberculous pleural effusion. AUC, area under curve; SE, standard error; CI, confidence interval.

Table 1

Demographic Data and Clinical Findings of the Subjects

Values are presented as mean±standard deviation or number (%).

Table 2

Biochemical and Cytological Parameters

Values are presented as mean±standard deviation.

RBC, red blood cell; WBC, white blood cell; LDH, Lactate dehydrogenase; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate.

Table 3

Diagnostic Properties of ADA Diagnosing Tuberculous Pleural Effusion at Cut-off Point in the Study Subjects

ADA, adenosine deaminase; CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value.

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