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Review
. 2013 Aug 30;9(4):601-7.
doi: 10.5114/aoms.2013.36904. Epub 2013 Aug 8.

Diagnostic accuracy of adenosine deaminase for tuberculous peritonitis: a meta-analysis

Yong-Chun Shen  1 , Tao Wang, Lei Chen, Ting Yang, Chun Wan, Qian-Jing Hu, Fu-Qiang Wen
Affiliations
Review

Diagnostic accuracy of adenosine deaminase for tuberculous peritonitis: a meta-analysis

Yong-Chun Shen et al. Arch Med Sci. .

Abstract

Introduction: Tuberculous peritonitis remains a diagnostic challenge for clinicians. Many studies have investigated the usefulness of adenosine deaminase (ADA) in ascites for the diagnosis of tuberculous peritonitis; however, the overall diagnostic accuracy of ADA for tuberculous peritonitis remains unclear. The aim of the present meta-analysis was to determine the overall accuracy of ADA measurements in the diagnosis of tuberculous peritonitis.

Material and methods: We performed a systematic search in PubMed and Embase to identify published studies that evaluated the diagnostic role of ADA for tuberculous peritonitis. Quality was assessed according to standardized Quality Assessment of Diagnostic Accuracy Studies criteria. Sensitivity, specificity and other measures of accuracy of ADA assay in order to diagnose tuberculous peritonitis were pooled using random effects models. Summary receiver operating characteristic curve (SROC) was used to summarize overall test performance.

Results: Sixteen studies met inclusion criteria for the present meta-analysis. The pooled sensitivity and specificity for diagnosing tuberculous peritonitis were 0.93 (95% CI: 0.89-0.95) and 0.96 (95% CI: 0.94-0.97), respectively. The positive likelihood ratio was 15.80 (95% CI: 10.87-22.95), negative likelihood ratio was 0.09 (95% CI: 0.05-0.16) and diagnostic odds ratio was 249.28 (95% CI: 113.11-549.39). The area under the SROC was 0.98.

Conclusions: Ascitic ADA determination is a relatively sensitive and specific test for the diagnosis of tuberculous peritonitis. Measurement of ADA in ascites is thus likely to be a useful diagnostic method for tuberculous peritonitis.

Keywords: adenosine deaminase; meta-analysis; tuberculous peritonitis.

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Figures

Figure 1
Figure 1
Forest plots of pooled sensitivity of ADA for the diagnosis of TBP. The point estimates of sensitivity from each study are shown as solid circles. Error bars indicate 95% confidence intervals
Figure 2
Figure 2
Forest plots of pooled specificity of ADA for the diagnosis of TBP. The point estimates of specificity from each study are shown as solid circles. Error bars indicate 95% confidence intervals
Figure 3
Figure 3
Summary receiver operating characteristic (SROC) curve of ADA for the diagnosis of TBP. The size of each solid circle represents the size of each study included in the present meta-analysis. The regression SROC curve indicates the overall diagnostic accuracy
Figure 4
Figure 4
Linear regression test of funnel plot asymmetry. The statistically non-significant value (p = 0.86) for the slope coefficient suggests symmetry in the data and a low likelihood of publication bias
See this image and copyright information in PMC

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