Chest Infections |

Very High Level of ADA in Pleural Effusions, Uncommon in Tuberculosis FREE TO VIEW

Patricia Lazo Meneses, MD; Esteban Perez Rodriguez, PhD; Carolina Gotera, MD; Jonathan Cámara Fernández, MD; Deisy Barrios Barreto, MD; Salvador Diaz Lobato, PhD; Sagrario Mayoralas Alises, PhD; Eva Mañas Baena, PhD; Rosa Mirambeaux Villalona, MD
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Hospital Universitario Ramón y Cajal, Madrid, Spain

Chest. 2014;145(3_MeetingAbstracts):154A. doi:10.1378/chest.1821597
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SESSION TITLE: Respiratory Infections

SESSION TYPE: Slide Presentations

PRESENTED ON: Sunday, March 23, 2014 at 04:15 PM - 05:15 PM

PURPOSE: INTRODUCTION Elevated ADA levels in pleural fluid are highly suggestive of pleural tuberculosis. In fact, values above 35UL in our practice present levels of sensitivity and specificity > 90%. However, sometimes we find very high levels of ADA Pleural uncommon for tuberculosis. Is there an upper limit level of ADA to justify the possibility of another process? OBJECTIVES: 1.- Identify the high levels of ADA and correlate the most prevalent etiology. 2.- Assess whether a high level of ADA is exclusive of pleural tuberculosis.

METHODS: From 1994 to October 2011, 2413 consecutive pleural effusions (PE) were studied, following the protocol in our Pleura Unit and were included in our database .The cases were studied along the lines of the unit. All cases were closed with a final diagnosis according to study results of pleural fluid, biopsy, treatment response and outcome. ADA levels in pleural fluid were analyzed by the method of Black Berman and expressed in U/L. The descriptive statistical analysis was applied, yielding half 28.26UI ADA with a DS of 37.13UI.

RESULTS: 2221 from 2413 cases, the levels of ADA were analyzed. 1391 were men (62.6%) and 830 women (37.4%), with an age average 65 years. Etiologic groups studied were:166 (7.47%) Tuberculosis, 478 (21.5%) malignant, 280 (12.6%) paramalignant, 77 (3.46%) ascitic hydrothorax , 188 (8.46%) cardiac, 20 (0.9%) connective tissue disease, 59 (2.65%) empyema, 70 (3.15%) lymphoma, 259 (11.6%) parapneumonic no empyema, 205 (9.23%) idiopathic, and to a lesser extent the rest of pathologies. ADA levels > 100UI were found in: Empyema 20 of 59 (33.89%), lymphomas, 10 of 70 (7%) tuberculosis 6 of 166 (3.75%). Mean levels of ADA and DS by etiology were frequently according to the table

CONCLUSIONS: 1.-The most common causes of pleural effusions with very high levels of ADA were lymphoproliferative processes, carcinomas, paramalignant and empyema. 2.-ADA levels above 100UI, make it unlikely tuberculosis diagnosis (3.75%)

CLINICAL IMPLICATIONS: The estimation of ADA level in pleural fluid is extremely helpful in establishing the aetiology of tubercular pleural effusion and to rule out other diagnoses, especially of other diseases in which lymphocyte predominance of pleural effusion is seen such as malignancy. In our practice, and given the prevalence of TB, very high levels of ADA are indicative of other processes, most malignant type or empyema.

DISCLOSURE: The following authors have nothing to disclose: Patricia Lazo Meneses, Esteban Perez Rodriguez, Carolina Gotera, Jonathan Cámara Fernández, Deisy Barrios Barreto, Salvador Diaz Lobato, Sagrario Mayoralas Alises, Eva Mañas Baena, Rosa Mirambeaux Villalona

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