Pericardial Effusion - ADA (Adenosine Deaminase) Test

5/01/02 (Chun)

Question: What is the utility of testing for ADA levels in pericardial fluid drawn from patients with pericardial effusion? 

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Unique Identifier:11834663

Authors: Burgess LJ. Reuter H. Taljaard JJ. Doubell AF.

Institution: Department of Chemical Pathology, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa. treades@iafrica.com

Title: Role of biochemical tests in the diagnosis of large pericardial effusions.

Source: Chest. 121(2):495-9, 2002 Feb.

Abstract: STUDY OBJECTIVES: To determine the biochemical characteristics of large pericardial effusions in various disease states, and to assess their utility as diagnostic tools. SETTING: An academic university hospital in the Western Cape, South Africa. DESIGN: Consecutive, prospective case series. PATIENTS: One hundred ten hospital patients > 12 years old, who presented to the echocardiography department with large pericardial effusions, and 12 control subjects who underwent open-heart surgery (coronary artery bypass graft or aortic valve replacement). MEASUREMENTS: Fluid was sent for examination of biochemistry, adenosine deaminase, microbiology, hematology, and cytology. The etiology of each pericardial fluid sample was established using predetermined criteria. RESULTS: The biochemistry of pericardial exudates differed significantly from pericardial transudates. Light' s criteria (whereby an exudate is defined as having one or more of the following: pleural fluid/serum protein ratio > 0.5; pleural fluid/serum lactate dehydrogenase [LDH] ratio > 0.6; and/or pleural fluid LDH level > 200 U/L) were applied to pericardial fluids and demonstrated to be the most reliable diagnostic tool for identifying pericardial exudates. The corresponding sensitivity was 98%. CONCLUSION: Although laboratory tests are a useful guideline when assessing the etiology and pathophysiology of pericardial effusions, the majority of large, clinically significant pericardial effusions result from exudative causes. CAS Registry/EC Number 57-88-5 (Cholesterol). 635-65-4 (Bilirubin). EC 1-1-1-27 (Lactate Dehydrogenase).

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Unique Identifier:11173777

Authors: Aggeli C. Pitsavos C. Brili S. Hasapis D. Frogoudaki A. Stefanadis C. Toutouzas P.

Institution: Cardiology Department, University of Athens, Hippokration Hospital, Athens, Greece. baskal@hol.gr

Title: Relevance of adenosine deaminase and lysozyme measurements in the diagnosis of tuberculous pericarditis.

Source: Cardiology. 94(2):81-5, 2000.

Abstract: OBJECTIVE: To assess the value of pericardial fluid adenosine deaminase (ADA) and pericardial lysozyme (Lys) as tools in diagnosing tuberculous pericarditis. METHODS: Forty-one patients (age range 17--77 years) with significant pericardial effusion were included in the study. Diagnostic pericardiocentesis and pericardial biopsy were performed while serum and pericardial fluid ADA and Lys were measured in all patients. Grouping of patients resulted as follows: group I = 7 patients with tuberculous pericarditis; group II = patients with neoplastic pericarditis; group III = 30 patients with idiopathic pericarditis. RESULTS: Pairwise multiple comparison procedures revealed a significant difference of ADA in group I versus group III (p < 0.05) but not versus group II. Furthermore, pericardial Lys in group I was higher than in groups II and III (p < 0.05). A strong correlation between pericardial ADA and Lys was found (r = 0.733, p = 0.01) for all the patients. Receiver operating curves showed a value of 72 U/l as cutoff point of pericardium ADA, with a sensitivity of 100% and a specificity of 94% in the diagnosis of tuberculous pericarditis. Similarly for pericardial Lys, a value of 6.5 microg/dl had a sensitivity and specificity of 100 and 91.17%, respectively. CONCLUSIONS: Both measurements of pericardial ADA and Lys need to be taken into account when attempting the early diagnosis of tuberculous pericarditis. Copyright 2001 S. Karger AG, Basel CAS Registry/EC Number EC 3-2-1-17 (Muramidase). EC 3-5-4-4 (Adenosine Deaminase).

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Unique Identifier:10532206

Authors: Dogan R. Demircin M. Sarigul A. Ciliv G. Bozer AY.

Institution: Department of Thoracic and Cardiovascular Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey.

Title: Diagnostic value of adenosine deaminase activity in pericardial fluids.

Source: Journal of Cardiovascular Surgery. 40(4):501-4, 1999 Aug.

Abstract: BACKGROUND: The activity of adenosine deaminase (ADA) was determined in serum and pericardial fluid of 70 patients (ages 21 to 71 years) with pericardial effusions of various etiologies and in 15 control subjects. METHODS: The patients were subdivided into five groups on the basis of definite diagnosis: 1) 24 patients with tuberculosis; 2) 22 with malignancies; 3) 12 with uremic pericarditis; 4) 12 with purulent pericarditis; 5) 15 control individuals without pericardial disease. The activity of ADA was determined at the same time in serum and cell-free pericardial fluid according to the method of Karker with minor modification. RESULTS: Mean (+/-SD) ADA activity in pericardial fluid was 66.92+/-4.12 IU/L in group 1; 27.50+/-6.02 in group 2; 28.65+/-4.73 in group 3; 53.05+/-11.14 in group 4; and 5.67+/-1.99 in group 5. Comparing the level achieved in group 1 with all others, the difference is significant at the p<0.001 level. When the cut-off value of 50 IU/L is used the sensitivity of the test for diagnosis of tuberculous effusion is 1, and the specificity is 0.83. Statistical analysis showed that there was no correlation between serum ADA activity and ADA activity in pericardial fluid. CONCLUSIONS: We recommend that determinations of ADA activity in pathologic pericardial fluids seem to be of great value in the early diagnosis of tuberculous pericardial effusions. Levels above 50 IU/L in effusions indicate probable tuberculosis. CAS Registry/EC Number EC 3-5-4-4 (Adenosine Deaminase).

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Unique Identifier:8665976

Authors: Komsuoglu B. Goldeli O. Kulan K. Komsuoglu SS.

Institution: Department of Medicine, Black Sea Technical University Medical School, Trabzon, Turkey.

Title: The diagnostic and prognostic value of adenosine deaminase in tuberculous pericarditis.

Source: European Heart Journal. 16(8):1126-30, 1995 Aug.

Abstract: Because of the difficulty in isolating the causative organism, pericardial tuberculosis is rarely diagnosed. Adenosine deaminase activity measured in the pericardial fluid of 108 patients was initially of undetermined origin. Subsequently, we classified five sources: (1) tuberculosis (20 cases); (2) idiopathy (82 cases); (3) neoplasia (three cases); (4) purulent bacterial infection (two cases); and (5) radiotherapy (one case). The highest mean adenosine deaminase value (126 +/- 16.68 U.l(-1) was found in group 1; other values were 29.4 +/- 8.9, 27 +/- 7.21, 29.5 +/- 13.4, 26 U.l(-1) in the idiopathy, neoplasia, purulent bacterial infection and radiotherapy groups, respectively. there was a statistically significant difference between group 1 and the other groups (P less than 0.001), indicating that the adenosine deaminase value has 100% sensitivity and 91% specificity. In addition, there was a positive correlation between high adenosine deaminase values and the development of constrictive pericarditis. In this study, two patients required pericardectomy. Therefore, the adenosine deaminase value is a significant prognostic indicator for the development of constrictive pericarditis in tuberculous pericarditis. CAS Registry/EC Number EC 3-5-4-4 (Adenosine Deaminase).

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Unique Identifier:6731043

Authors: Pettersson T. Ojala K. Weber TH.

Title: Adenosine deaminase in the diagnosis of pleural effusions.

Source: Acta Medica Scandinavica. 215(4):299-304, 1984.

Abstract: The activity of adenosine deaminase (ADA) was determined in serum and pleural fluid of 90 patients with pleural effusions of various aetiology. Tuberculous pleural effusions, empyemas and rheumatoid pleural effusions demonstrated significantly higher activities of ADA than parapneumonic , nonspecific and malignant pleural effusions and effusions in systemic lupus erythematosus and congestive heart failure. In tuberculosis, empyema and rheumatoid arthritis ADA activity was significantly higher in pleural fluid than in serum, indicating a local synthesis of ADA by cells within the pleural cavity in these diseases. CAS Registry/EC Number EC 3-5-4 (Nucleoside Deaminases). EC 3-5-4-4 (Adenosine Deaminase).

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Unique Identifier:737480

Authors: Piras MA. Gakis C. Budroni M. Andreoni G.

Title: Adenosine deaminase activity in pleural effusions: an aid to differential diagnosis.

Source: BMJ. 2(6154):1751-2, 1978 Dec 23-30.

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