Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Diagnostic Accuracy of Lactate Dehydrogenase/Adenosine Deaminase Ratio in Differentiating Tuberculous and Parapneumonic Effusions: A Systematic Review

  • Larry Ellee Nyanti (Medical Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah) ;
  • Muhammad Aklil Abd Rahim (Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah) ;
  • Nai-Chien Huan (Department of Respiratory Medicine, Queen Elizabeth Hospital)
  • Received : 2023.08.07
  • Accepted : 2023.09.12
  • Published : 2024.01.31
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Abstract

Background: Tuberculous pleural effusion (TPE) and parapneumonic effusion (PPE) are often difficult to differentiate owing to the overlapping clinical features. Observational studies demonstrate that the ratio of lactate dehydrogenase to adenosine deaminase (LDH/ADA) is lower in TPE compared to PPE, but integrated analysis is warranted. Methods: We conducted a systematic review to evaluate the diagnostic accuracy of the LDH/ADA ratio in differentiating TPE and PPE. We explored the PubMed and Scopus databases for studies evaluating the LDH/ADA ratio in differentiating TPE and PPE. Results: From a yield of 110 studies, five were included for systematic review. The cutoff value for the LDH/ADA ratio in TPE ranged from <14.2 to <25. The studies demonstrated high heterogeneity, precluding meta-analysis. Quality Assessment of Diagnostic Accuracy Studies Tool 2 assessment revealed a high risk of bias in terms of patient selection and index test. Conclusion: LDH/ADA ratio is a potentially useful parameter to differentiate between TPE and PPE. Based on the limited data, we recommend an LDH/ADA ratio cutoff value of <15 in differentiating TPE and PPE. However, more rigorous studies are needed to further validate this recommendation.

Keywords

Acknowledgement

The authors would like to thank Universiti Malaysia Sabah for sponsoring the publication fees for this article.

References

  1. Lo Cascio CM, Kaul V, Dhooria S, Agrawal A, Chaddha U. Diagnosis of tuberculous pleural effusions: a review. Respir Med 2021;188:106607. 
  2. Mehta AA, Belagundi P, Oommen MS, Paul T, Haridas N, Kumar A. Performance of Xpert MTB/RIF assay on thoracoscopic pleural biopsy in undiagnosed exudative pleural effusion. Indian J Tuberc 2022;69:635-40.  https://doi.org/10.1016/j.ijtb.2021.09.010
  3. Huan NC, Khor IS, Ramarmuty HY, Lim MY, Ng KC, Syaripuddin A, et al. Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion. Proc Singap Healthc 2021;30:271-8.  https://doi.org/10.1177/2010105820978998
  4. Lin L, Li S, Xiong Q, Wang H. A retrospective study on the combined biomarkers and ratios in serum and pleural fluid to distinguish the multiple types of pleural effusion. BMC Pulm Med 2021;21:95. 
  5. Wang J, Liu J, Xie X, Shen P, He J, Zeng Y. The pleural fluid lactate dehydrogenase/adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusions. BMC Pulm Med 2017;17:168. 
  6. Beukes A, Shaw JA, Diacon AH, Irusen EM, Koegelenberg CF. The utility of pleural fluid lactate dehydrogenase to adenosine deaminase ratio in pleural tuberculosis. Respiration 2021;100:59-63.  https://doi.org/10.1159/000509555
  7. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg 2021;88:105906. 
  8. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011;155:529-36.  https://doi.org/10.7326/0003-4819-155-8-201110180-00009
  9. Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 2006;6:31. 
  10. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-60.  https://doi.org/10.1136/bmj.327.7414.557
  11. Blakiston M, Chiu W, Wong C, Morpeth S, Taylor S. Diagnostic performance of pleural fluid adenosine deaminase for tuberculous pleural effusion in a low-incidence setting. J Clin Microbiol 2018;56:e00258-18. 
  12. Ho CY, Tsai YH, Chang CC, Huang HL, Tan NC, Chen WC, et al. The role of pleural fluid lactate dehydrogenase-to-adenosine deaminase ratio in differentiating the etiology of pleural effusions. Chin J Physiol 2022;65:105-8.  https://doi.org/10.4103/cjp.cjp_104_21
  13. Chen YY, Pan SW, Shen HS, Chuang FY, Feng JY, Su WJ. Declining trend in incidence of tuberculosis in adolescents and young adults in Taiwan. Eur Respir J 2019;53:1801305. 
  14. Li L, Xi Y, Ren F. Spatio-temporal distribution characteristics and trajectory similarity analysis of tuberculosis in Beijing, China. Int J Environ Res Public Health 2016;13:291. 
  15. Hu W, Liu W, Hou J, Ong Z, Liu Y. Epidemiological characteristics and temporal-spatial clustering analysis of tuberculosis in Guangzhou from 2010 to 2019. Chin J of Dis Control Prev 2020;24:1037-41. 
  16. Song D, Lun AR, Chiu W. Diazyme adenosine deaminase in the diagnosis of tuberculous pleural effusion: method evaluation and clinical experiences in a New Zealand population. N Z J Med Lab Sci 2010;64:11-3. 
  17. Lee J, Yoo SS, Lee SY, Cha SI, Park JY, Kim CH. Pleural fluid adenosine deaminase/serum C-reactive protein ratio for the differentiation of tuberculous and parapneumonic effusions with neutrophilic predominance and high adenosine deaminase levels. Infection 2017;45:59-65. https://doi.org/10.1007/s15010-016-0928-5