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Introduction: Increased pleural fluid adenosine deaminase (ADA) activity is classically associated with tuberculous  pleural effusion. However, increased activity can a lso occur in a number of other diseases and this ma y negatively affect the diagnostic utility of ADA measurements and decr ease its specificity for the diagnosis of tuberculo sis (TB). The presence of ADA in pleural fluids reflects the cell ular immune response in the pleural cavity and in p articularly, the activation of T lymphocytes. Different disease enti ties are typically associated with the presence of particular types of leukocytes. Objective of present study is to evalua te efficacy of combined use of ADA activity and lymphocyte/neutrophil ratio for diagnosing tubercul ous pleural effusion. Methods: Biochemistry, cytology, and microbiology studies were performed on 164 consecut ive pleural fluids. ADA and differential cell count s were determined on all exudative effusions. Results: Pleural fluid ADA activity at a level of ≥40 U/L have sensitivity=95.5%, specificity=93.4%, positive pred iction value=94.4%, negative prediction value=94.7% and efficacy= 94.5 %. It was statistically significant (p value<0 .0 1). When the additional requirement of a lymphoc yte/neutrophil ratio of ≥0.75 was included they have sensitivity=95.45, spec ificity=100%, positive prediction value=100%, negat ive prediction value=97.45 and efficacy=97.5 respective ly. Conclusion: ADA is a highly sensitive diagnostic marker of tubercular pleural effusion. Combined pleural fluid ADA and Lymphocyte /neutrophil ratio increases dia gnostic accuracy in tubercular pleural effusion patients co mpared to pleural fluid ADA alone.

Diagnostic accuracy of combined Pleural fluid Adeno sine Deaminase and Lymphocyte/Neutrophil ratio in Tubercular pleur al effusion