Factors affecting Pleural Fluid Adenosine Deaminase level and the implication on the Diagnosis of Tuberculous Pleural Effusion

Abstract

Background: Pleural effusions, a frequent manifestation in various pulmonary conditions, present significant diagnostic challenges, particularly in distinguishing Tuberculous Pleural Effusion (TPE) from other types. The critical role of Adenosine Deaminase (ADA) in this diagnostic process emerges from its ability to reflect the activity of the immune system, particularly in response to mycobacterial infections like tuberculosis.   Objective: This study aims to determine the optimal ADA levels for TPE evaluation and the factors influencing pleural fluid ADA levels.   Methodology: A retrospective study was conducted using the multicenter approach at District Headquarters Hospital Charsadda and Jinnah Hospital Peshawar between January 2021 and January 2022. The data was analyzed from 150 patients whose pleural fluid ADA was done to look into pleural effusion. Using the Diazyme ADA assay, the total ADA was calculated calorimetrically. Factors including peripheral blood counts, pleural fluid properties, and demographics were examined. SPSS 23.0 was used to analyze all data.   Results: Most 93 males (62%) had a mean age of 57.8±7.66 years. A total of 125 (83.3%) cases of non-TPE and 25 (16.7%) cases of TPE were observed. The most common cause of exudative pleural effusion was malignant in 61 (40.6%) cases, followed by acute bacterial infection in 23 (15.3%). In Tuberculous Pleural Effusion, the optimal cutoff point and mean levels of ADA were 30 IU/L and 41.1±17.3, respectively. In tuberculous pleural effusions, there was a weak positive correlation (r = 0.-24, P = 0.004) between ADA as well as fluid protein, LDH (r = 0.22, P <0.05); however, there was a negative correlation (r = -0.30, p = 0.02) with age.   Conclusion: The current study found that in patients with tuberculous pleural effusion, the mean and deadline points of the ADA were relatively low. When interpreting pleural fluid ADA levels, it is important to consider the patient's age, amino acids, LDH levels, and other variables.