Association of Pericardial Fluid ADA Level and Definitive Tuberculous Pericarditis at Sunpasitthiprasong Hospital : a Cross-Sectional Analytic Study

Abstract

Background: Tuberculous pericarditis remains a common cause of pericarditis in Thailand but the diagnosis is still difficult and tend to be delayed. The previous studies show that ADA level from pericardial effusion can be used for early diagnosis of TB pericarditis but the cutoff point is varied that may cause severe complication and increase mortality.

Objective: To study the association of pericardial fluid ADA level and definitive TB pericarditis.

Methods: All patients who were suspected TB pericarditis and coded ICD10:A188 on provisional diagnosis at Sunpasitthiprasong Hospital between January 2014 and March 2019 were retrospectively reviewed. Pericardial fluid ADA level and other clinical data were collected and analyzed. The diagnosis accuracy of pericardial ADA level for definitive TB pericarditis was measured by using sensitivity, specificity, LR+, LR- and AROC

Result: 58 participants were included, 55.12% (32/58) were classified as definitive TB pericarditis, 36.20% (21/58) as probable TB pericarditis and 8.62% (5/58) as non-TB pericarditis. None of the participants were HIV positive. The diagnosis was confirmed by pericardiocentesis and pericardial biopsy in all participants. The AROC of pericardial fluid ADA level for predicting definitive TB pericarditis was 0.561. The best pericardial fluid ADA cutoff point was ≥50 U/L which yielded sensit ivity, specificity, PPV, NPV and AROC of 81.25%, 38.46%, 61.90%, 62.50% and 0.599, respectively. However, the result of each ADA cutoff point was not significantly different in this study.

Conclusion: Pericardial fluid ADA level was not a good diagnosis tool for TB pericarditis in Thailand. There was no appropriated cutoff point in the study. The pericardial biopsy and tuberculosis culture were still required in all patients who suspected TB pericarditis.

Keywords: Tuberculous pericarditis, Tuberculosis, Extrapulmonary TB, Pericardial fluid ADA, Pericardial effusion, Pericarditis, Diagnosis