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Vol. 55. Num. 1.January 2019
Pages 1-64
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Vol. 55. Num. 1.January 2019
Pages 1-64
Original Article
DOI: 10.1016/j.arbr.2018.11.007
Diagnostic Accuracy of Pleural Fluid Adenosine Deaminase for Diagnosing Tuberculosis. Meta-analysis of Spanish Studies
Eficacia diagnóstica de la adenosina desaminasa en líquido pleural para diagnosticar tuberculosis. Metaanálisis de estudios españoles
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Rosa M. Palmaa, Silvia Bielsaa, Aureli Esquerdab, Montserrat Martínez-Alonsoc, José M. Porcela,
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jporcelp@yahoo.es

Corresponding author.
a Unidad de Medicina Pleural, Hospital Universitario Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
b Servicio de Análisis Clínicos, Hospital Universitario Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
c Unidad de Bioestadística y Epidemiología, IRBLLEIDA, Lleida, Spain
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Tables (4)
Table 1. Characteristics of Spanish Studies That Evaluated the Diagnostic Yield of Adenosine Deaminase in Pleural Fluid.
Table 2. Diagnostic Accuracy of Adenosine Deaminase in Tuberculous Pleural Effusion, According to the Measurement Method Used.
Table 3. Diagnostic Accuracy of Adenosine Deaminase in Tuberculous Pleural Effusion, According to the Cut-Off Point Used.
Table 4. Diagnostic Accuracy of Adenosine Deaminase in Tuberculous Pleural Effusion, According to Different Published Meta-analyses.
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Abstract
Objective

To evaluate the usefulness of pleural fluid adenosine deaminase (ADA) for diagnosing tuberculous pleural effusions in the Spanish population, according to laboratory technique and cut-off point, and to compare the results with other populations.

Methods

Meta-analysis of diagnostic studies on pleural fluid ADA in the Spanish population, extracted from the PubMed and Embase databases from inception until July 2017, with no language restrictions. The overall diagnostic accuracy of ADA and that of each of the measurement techniques (Giusti, manual and automated kinetic methods) and selected cut-offs were analyzed. The QUADAS-2 tool was used to evaluate the quality of studies. A bivariate random effects model was used. Results were compared with those obtained from previous meta-analyses in non-Spanish populations.

Results

Sixteen studies with a total of 4147 patients, 1172 of whom had tuberculous pleural effusions, were included. ADA had 93% sensitivity, 92% specificity, positive likelihood ratio of 12, negative likelihood ratio of 0.08, and an area-under-the-curve of 0.968 for identifying tuberculosis. There were no differences in diagnostic accuracy between the techniques used for ADA measurement or the selected cut-offs. In 73 studies from non-Spanish populations a trend toward lower ADA sensitivity (88%, 95% CI: 86%–90%) and specificity (88%, 95% CI: 86%–90%) was noted, but differences did not reach statistical significance.

Conclusions

Pleural fluid ADA in the Spanish population shows good diagnostic accuracy (regardless of the measurement technique or cut-off), similar to that reported in non-Spanish populations.

Keywords:
Adenosine deaminase
Tuberculous pleural effusion
Pleural fluid
Meta-analysis
Resumen
Objetivo

Determinar la utilidad de la adenosina desaminasa (ADA) pleural para diagnosticar derrame pleural tuberculoso en población española, según la técnica de medición y punto de corte utilizados, y compararla con la descrita para otras poblaciones.

Métodos

Metaanálisis de estudios diagnósticos sobre ADA pleural en población española, extraídos de PubMed y Embase desde sus comienzos hasta julio de 2017, sin restricciones de lenguaje. Se analizó la eficacia diagnóstica global de la ADA, según sus técnicas de medición (Giusti, métodos cinéticos manuales y métodos cinéticos automatizados) y el punto de corte seleccionado. La herramienta QUADAS-2 evaluó la calidad de los estudios. Se utilizó un método bivariante de efectos aleatorios. Se compararon los resultados con los descritos en metaanálisis previos sobre población no española.

Resultados

Se incluyeron 16 estudios, con 4.147 pacientes, de los que 1.172 tenían derrame pleural tuberculoso. La ADA tuvo una sensibilidad del 93%, especificidad del 92%, likelihood ratio positiva de 12, likelihood ratio negativa de 0,08, y área bajo la curva de 0,968 para identificar tuberculosis. No hubo diferencias de eficacia diagnóstica entre las técnicas de medición de ADA o el punto de corte escogido. En 73 estudios de población no española se observó una tendencia hacia una menor sensibilidad (88%, IC95%: 86-90%) y especificidad (88%, IC95% 86-90%) de la ADA, pero las diferencias no alcanzaron significación estadística.

Conclusiones

La ADA pleural en población española tiene una buena precisión diagnóstica (independientemente de la técnica de medición o punto de corte empleados), similar a la reportada en población no española.

Palabras clave:
Adenosina desaminasa
Derrame pleural tuberculoso
Líquido pleural
Metaanálisis

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