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KMID : 1044520240870010091
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Tuberculosis and Respiratory Diseases
2024 Volume.87 No. 1 p.91 ~ p.99
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Diagnostic Accuracy of Lactate Dehydrogenase/Adenosine Deaminase Ratio in Differentiating Tuberculous and Parapneumonic Effusions: A Systematic Review
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Larry Ellee Nyanti
Muhammad Aklil Abd Rahim
Nai-Chien Huan
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Abstract
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Background: Tuberculous pleural effusion (TPE) and parapneumonic effusion (PPE) areoften difficult to differentiate owing to the overlapping clinical features. Observationalstudies 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 theLDH/ADA ratio in differentiating TPE and PPE. We explored the PubMed and Scopusdatabases 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 cutoffvalue for the LDH/ADA ratio in TPE ranged from <14.2 to <25. The studies demonstratedhigh heterogeneity, precluding meta-analysis. Quality Assessment of DiagnosticAccuracy Studies Tool 2 assessment revealed a high risk of bias in terms of patientselection and index test.
Conclusion: LDH/ADA ratio is a potentially useful parameter to differentiate betweenTPE and PPE. Based on the limited data, we recommend an LDH/ADA ratio cutoff valueof <15 in differentiating TPE and PPE. However, more rigorous studies are needed tofurther validate this recommendation.
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KEYWORD
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Lactate Dehydrogenase, Adenosine Deaminase, Tuberculous Pleural Effusion, Parapneumonic Effusion, Diagnostic Accuracy
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