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Prasad MK, Kumar A, Nalini N, Kumar P, Mishra B, Lata D, Ashok C, Kumar D, Marandi S, Kumar D, Singh S, Mahajan M. Diagnostic Accuracy of Cerebrospinal Fluid (CSF) Adenosine Deaminase (ADA) for Tuberculous Meningitis (TBM) in Adults: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e39896. [PMID: 37404432 PMCID: PMC10316459 DOI: 10.7759/cureus.39896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
Tuberculous meningitis is the most serious complication of tuberculosis. Early diagnosis is crucial to start relevant treatment to prevent death and disability. Electronic databases PubMed, Google Scholar, and Cochrane Library were used to find relevant articles from January 1980 to June 2022. The random-effect model in terms of pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence interval was adopted to derive the diagnostic efficacy of cerebrospinal fluid (CSF) adenosine deaminase (ADA) for the diagnosis of tuberculous meningitis (TBM) in adult patients. A total of 22 studies (20 prospective and two retrospective data) have been included in this meta-analysis, having 1927 participants. We perceived acceptable pooled sensitivity, specificity, summary receiver operating characteristics (SROCs), and diagnostic odds ratio (DOR) of 0.85 (95% CI: 0.77-0.90), 0.90 (95% CI: 0.85-0.93), 0.94 (95% CI: 0.91-0.96) and 48 (95% CI: 26-86), respectively, for CSF-ADA for differentiating TBM from non-TBM in adult patients. To ascertain the certainty of evidence for CSF-ADA as a diagnostic marker for TBM, Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) analysis was used. CSF-ADA is an auspicious diagnostic test with a high degree of specificity and acceptable sensitivity for the diagnosis of tuberculous meningitis, however, with very low certainty of evidence.
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Affiliation(s)
| | - Amit Kumar
- Laboratory Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Neelam Nalini
- Obstetrics and Gynecology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Pramod Kumar
- Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Brajesh Mishra
- Pulmonary Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | | | - Chanchal Ashok
- Pathology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Dewesh Kumar
- Community Medicine/Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Sujeet Marandi
- Internal Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Divakar Kumar
- Internal Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Shreya Singh
- Internal Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Mayank Mahajan
- Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
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Ye Q, Yan W. Adenosine deaminase from the cerebrospinal fluid for the diagnosis of tuberculous meningitis: A meta-analysis. Trop Med Int Health 2023; 28:175-185. [PMID: 36591905 DOI: 10.1111/tmi.13849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To comprehensively evaluate the diagnostic efficacy of adenosine deaminase in cerebrospinal fluid (CSF) for tuberculous meningitis (TBM), and the potential influence of patients' age groups and cutoffs of measured adenosine deaminase. METHODS Systematic review and meta-analysis of relevant studies retrieved from PubMed, Embase, and Web of Science databases. Pooled sensitivity and specificity were calculated with a random-effect model. RESULTS Overall, 43 studies with 1653 patients with TBM and 3417 controls without were included. Pooled results showed that adenosine deaminase in CSF is associated with satisfactory diagnostic efficacy for TBM, with a pooled sensitivity of 0.86 (95% confidence interval [CI]: 0.82-0.90), specificity of 0.89 (95% CI: 0.86-0.91), positive likelihood ratio of 7.70 (95% CI: 6.16-9.63), and negative likelihood ratio of 0.15 (95% CI: 0.12-0.20). The pooled receiver operating characteristic (AUC) was 0.94 (95% CI: 0.91-0.96), suggesting good performance. Subgroup analyses showed good diagnostic efficacies of adenosine deaminase in CSF for both adults (AUC 0.95) and children (AUC 0.96) with TBM. AUCs indicating the diagnostic accuracies of adenosine deaminase in CSF for TBM were 0.93 for studies with cutoffs <10 U/L and and 0.94 for a cutoff =10 U/L, but only 0.90 for studies with cutoffs >10 U/L. CONCLUSIONS Measuring adenosine deaminase of CSF shows satisfactory diagnostic efficacy for TBM in children and adults, particularly if using a cutoff ≤10 U/L.
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Affiliation(s)
- Qin Ye
- Department of Pulmonary Medicine, Ningbo HwaMei Hospital, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Wang Yan
- Department of Neurology, Ningbo HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
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Zhu X, Hu J. Adenosine Deaminase is a Potential Molecular Marker for Diagnosis and Prognosis of Haemorrhagic Fever with Renal Syndrome. Infect Drug Resist 2022; 15:5197-5205. [PMID: 36090607 PMCID: PMC9462936 DOI: 10.2147/idr.s379228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/20/2022] [Indexed: 02/05/2023] Open
Abstract
Objective Haemorrhagic fever with renal syndrome (HFRS) is a serious zoonotic disease which seriously endangers physical health and mainly occurs in China. To date, there is still a lack of early and novel biomarkers to detect the severity of disease and prognosis of HFRS. This study was aimed to examine the value of the serum Adenosine deaminase (ADA) concentrations in the patients with HFRS. Methods The clinical and laboratory data of 124 adult patients with HFRS and 131 patients with similar clinical symptoms to HFRS were analyzed. A receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of ADA in HFRS. Results The ADA levels in the serum of HFRS patients were significantly higher than those in control patients (P < 0.001), and ADA has a strong positive correlation with HFRS (r = 0.785, P < 0.001). The optimal cut-off value of ADA for diagnosis of HFRS was 18 U/L and the area under the curve (AUC) was 0.953 (95% CI: 0.925, 0.981). The sensitivity was 84.8%, the specificity was 93.1%, the positive predictive value was 92.2%, the negative predictive value was 86.5% and the Youden index was 77.9%. Serum ADA levels in patients with HFRS tended to decrease at discharge compared with those at admission. Conclusion ADA could be a potential molecular marker for diagnosis and prognosis of HFRS patients.
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Affiliation(s)
- Xiaoli Zhu
- Department of Laboratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, People’s Republic of China
| | - Jinxi Hu
- Department of Oncological Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, People’s Republic of China,Correspondence: Jinxi Hu, Department of Oncological Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, No. 150 Ximen Road of Linhai, Taizhou, Zhejiang Province, 317000, People’s Republic of China, Tel +86 18257689350, Email
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Nakamura S, Fujioka T, Kawashima S, Kawaguchi T, Mizuno M, Omura M, Okita K, Kimura A, Shimohata T, Matsukawa N. Self-remitting Elevation of Adenosine Deaminase Levels in the Cerebrospinal Fluid with Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy: A Case Report and Review of the Literature. Intern Med 2021; 60:3031-3036. [PMID: 33814491 PMCID: PMC8502650 DOI: 10.2169/internalmedicine.6457-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 29-year-old man presented with a high-grade fever, headache, and urinary retention, in addition to meningeal irritation and myoclonus in his upper extremities. A cerebrospinal fluid (CSF) examination showed pleocytosis and high adenosine deaminase (ADA) levels with no evidence of bacterial infection, including Mycobacterium tuberculosis. T2-weighted brain magnetic resonance imaging showed transient hyper-intensity lesions at the splenium of the corpus callosum (SCC), bilateral putamen, and pons during the course of the disease. The CSF was positive for anti-glial fibrillary acidic protein (GFAP) antibodies. He was diagnosed with autoimmune GFAP astrocytopathy. The present case shows that the combination of an elevated ADA level in the CSF and reversible T2-weighted hyper-intensity on the SCC supports the diagnosis of autoimmune GFAP encephalopathy.
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Affiliation(s)
- Sota Nakamura
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Teppei Fujioka
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Shoji Kawashima
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Takatsune Kawaguchi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Masayuki Mizuno
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Masahiro Omura
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Kenji Okita
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
| | | | - Noriyuki Matsukawa
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Japan
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Gao ZW, Wang X, Zhang HZ, Lin F, Liu C, Dong K. The roles of adenosine deaminase in autoimmune diseases. Autoimmun Rev 2020; 20:102709. [PMID: 33197575 DOI: 10.1016/j.autrev.2020.102709] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
Autoimmune diseases patients are characterized by the autoimmune disorders, whose immune system can't distinguish between auto- and foreign- antigens. Thus, Immune homeostasis disorder is the key factor for autoimmune diseases development. Adenosine deaminase (ADA) is the degrading enzyme for an immunosuppressive signal - adenosine, and play an important role in immune homeostasis regulation. Increasing evidences have shown that ADA is involved in various autoimmune diseases. ADA activity were changed in multiple autoimmune diseases patients and could be served as a biomarker for clinical diagnosis. In this study, we analyze the change of ADA activity in patients with autoimmune diseases, and we underline its potential diagnostic value for autoimmune diseases patients.
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Affiliation(s)
- Zhao-Wei Gao
- Department of Clinical Diagnose, Tangdu Hospital, Airforce military medical university, Xi'an City, Shannxi Province, China
| | - Xi Wang
- Department of Clinical Diagnose, Tangdu Hospital, Airforce military medical university, Xi'an City, Shannxi Province, China
| | - Hui-Zhong Zhang
- Department of Clinical Diagnose, Tangdu Hospital, Airforce military medical university, Xi'an City, Shannxi Province, China
| | - Fang Lin
- Department of Clinical Diagnose, Tangdu Hospital, Airforce military medical university, Xi'an City, Shannxi Province, China
| | - Chong Liu
- Department of Clinical Diagnose, Tangdu Hospital, Airforce military medical university, Xi'an City, Shannxi Province, China
| | - Ke Dong
- Department of Clinical Diagnose, Tangdu Hospital, Airforce military medical university, Xi'an City, Shannxi Province, China.
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