{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:57:40Z","timestamp":1788976660522,"version":"build-2803163510"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T00:00:00Z","timestamp":1663718400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T00:00:00Z","timestamp":1663718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Increased pleural fluid adenosine deaminase (ADA) is useful for diagnosing tuberculous pleurisy (TB), but high ADA levels are associated with other diseases. In this study, we compare various disease characteristics in patients with high-ADA pleural effusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively collected data for 456 patients with pleural fluid ADA levels of \u2265\u200940 U\/L from January 2012 to October 2021. Cases were classified as TB (n\u2009=\u2009203), pleural infection (n\u2009=\u2009112), malignant pleural effusion (n\u2009=\u200963), nontuberculous mycobacteria (n\u2009=\u200922), malignant lymphoma (ML) (n\u2009=\u200918), autoimmune diseases (n\u2009=\u200911), and other diseases (n\u2009=\u200927), and data were compared among those diseases. Predictive factors were identified by comparing data for a target disease to those for all other diseases. A diagnostic flowchart for TB was developed based on those factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The most frequent disease was TB, though 60.0% of patients were diagnosed with other diseases. Median ADA levels in patients with TB were 83.1 U\/L (interquartile range [IQR] 67.2\u2013104.1), higher than those of patients with pleural infection (median 60.9 [IQR 45.3\u2013108.0],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004), malignant pleural effusion (median 54.1 [IQR 44.8\u201366.7],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), or autoimmune diseases (median 48.5 [IQR 45.9\u201358.2],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008), with no significant difference from NTM (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.000) or ML (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.000). Pleural fluid lactate dehydrogenase (LDH) levels of &lt;\u2009825 IU\/L were beneficial for the diagnosis of TB. Neutrophil predominance or cell degeneration, white blood cell count of \u2265\u20099200\/\u00b5L or C-reactive protein levels of \u2265\u200912\u00a0mg\/dL helped in diagnosing pleural infection. Pleural fluid amylase levels of \u2265\u200975 U\/L and a pleural fluid ADA\/total protein (TP) ratio of &lt;\u200914 helped in diagnosing malignant pleural effusion. High serum LDH and high serum\/pleural fluid eosinophils helped in diagnosing ML and autoimmune diseases, respectively. The flowchart was comprised of the following three factors: pleural fluid LDH\u2009&lt;\u2009825 IU\/L, pleural fluid ADA\/TP of &lt;\u200914, and neutrophil predominance or cell degeneration, which were decided by a decision tree. The diagnostic accuracy rate, sensitivity, and specificity for the diagnosis of TB were 80.9%, 78.8%, and 82.6%, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cases involving high pleural fluid ADA levels should be investigated using several factors to distinguish TB from other diseases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12890-022-02150-4","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T14:03:16Z","timestamp":1663768996000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Characteristics of pleural effusion with a high adenosine deaminase level: a case\u2013control study"],"prefix":"10.1186","volume":"22","author":[{"given":"Masafumi","family":"Shimoda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aya","family":"Hirata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiaki","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kozo","family":"Morimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Yoshiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kozo","family":"Yoshimori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Saraya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruyuki","family":"Ishii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Ohta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,9,21]]},"reference":[{"issue":"3","key":"2150_CR1","doi-asserted-by":"publisher","first-page":"e02137","DOI":"10.1371\/journal.pone.0213728","volume":"14","author":"AN Aggarwal","year":"2019","unstructured":"Aggarwal AN, Agarwal R, Sehgal I, Dhooria S. 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The need for informed consent was waived by the ethics committee\/Institutional Review Board of the Institutional Review Board of Fukujuji Hospital and Kyorin University School of Medicine because of the retrospective nature of the study. The decisions made by this board are based on and in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors state that they have no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"359"}}