{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:43:56Z","timestamp":1789670636012,"version":"4.0.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"MultiDimensional Diagnostic Strategies for Tuberculosis and Research and Development of Innovative Products Program","award":["2018ZX10302301"],"award-info":[{"award-number":["2018ZX10302301"]}]},{"name":"Shanghai Clinical Research Center for Infectious Diseases","award":["19MC1910800"],"award-info":[{"award-number":["19MC1910800"]}]},{"name":"Shanghai science and technology commission project","award":["20Y11901500"],"award-info":[{"award-number":["20Y11901500"]}]},{"name":"Shanghai Key Clinical Specialty Construction Project","award":["shslczdzc03001"],"award-info":[{"award-number":["shslczdzc03001"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"DOI":"10.1186\/s12890-025-03947-9","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T11:34:09Z","timestamp":1761564849000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic performance of adenosine deaminase activity in pleural fluid in tuberculous pleural effusion and relevant factors: a single-center experience with 1,491 consecutive patients"],"prefix":"10.1186","volume":"25","author":[{"given":"Chi","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaojun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengting","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haili","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Hao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Sha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"key":"3947_CR1","unstructured":"WHO. Global tuberculosis report 2014: World Health Organization; 2014. Available from: http:\/\/www.who.int\/tb\/publications\/global_report\/en\/."},{"issue":"3","key":"3947_CR2","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1111\/j.1440-1843.2010.01723.x","volume":"15","author":"RW Light","year":"2010","unstructured":"Light RW. Update on tuberculous pleural effusion. Respirology. 2010;15(3):451\u20138.","journal-title":"Respirology"},{"issue":"2","key":"3947_CR3","first-page":"89","volume":"41","author":"AN Aggarwal","year":"1999","unstructured":"Aggarwal AN, Gupta D, Jindal SK. Diagnosis of tuberculous pleural effusion. Indian J Chest Dis Allied Sci. 1999;41(2):89\u2013100.","journal-title":"Indian J Chest Dis Allied Sci"},{"issue":"6","key":"3947_CR4","first-page":"981","volume":"7","author":"MJ Vorster","year":"2015","unstructured":"Vorster MJ, Allwood BW, Diacon AH, Koegelenberg CF. Tuberculous pleural effusions: advances and controversies. J Thorac Dis. 2015;7(6):981\u201391.","journal-title":"J Thorac Dis"},{"issue":"4","key":"3947_CR5","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1097\/MCP.0b013e32833a7154","volume":"16","author":"R Krenke","year":"2010","unstructured":"Krenke R, Korczynski P. Use of pleural fluid levels of adenosine deaminase and interferon gamma in the diagnosis of tuberculous pleuritis. Curr Opin Pulm Med. 2010;16(4):367\u201375.","journal-title":"Curr Opin Pulm Med"},{"issue":"7","key":"3947_CR6","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1007\/s10875-017-0433-3","volume":"37","author":"KL Bradford","year":"2017","unstructured":"Bradford KL, Moretti FA, Carbonaro-Sarracino DA, Gaspar HB, Kohn DB. Adenosine deaminase (ADA)-deficient severe combined immune deficiency (SCID): molecular pathogenesis and clinical manifestations. J Clin Immunol. 2017;37(7):626\u201337.","journal-title":"J Clin Immunol"},{"key":"3947_CR7","doi-asserted-by":"crossref","unstructured":"Hooper C, Lee YC, Maskell N, Group BTSPG. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii4\u201317.","DOI":"10.1136\/thx.2010.136978"},{"issue":"6154","key":"3947_CR8","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1136\/bmj.2.6154.1751-a","volume":"2","author":"MA Piras","year":"1978","unstructured":"Piras MA, Gakis C, Budroni M, Andreoni G. Adenosine deaminase activity in pleural effusions: an aid to differential diagnosis. Br Med J. 1978;2(6154):1751\u20132.","journal-title":"Br Med J"},{"issue":"10","key":"3947_CR9","first-page":"3126","volume":"7","author":"X Gui","year":"2014","unstructured":"Gui X, Xiao H. Diagnosis of tuberculosis pleurisy with adenosine deaminase (ADA): a systematic review and meta-analysis. Int J Clin Exp Med. 2014;7(10):3126\u201335.","journal-title":"Int J Clin Exp Med"},{"issue":"Pt 4","key":"3947_CR10","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1258\/000456303766477011","volume":"40","author":"M Goto","year":"2003","unstructured":"Goto M, Noguchi Y, Koyama H, Hira K, Shimbo T, Fukui T. Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis. Ann Clin Biochem. 2003;40(Pt 4):374\u201381.","journal-title":"Ann Clin Biochem"},{"issue":"5","key":"3947_CR11","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1016\/j.rmed.2007.12.007","volume":"102","author":"QL Liang","year":"2008","unstructured":"Liang QL, Shi HZ, Wang K, Qin SM, Qin XJ. Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy: a meta-analysis. Respir Med. 2008;102(5):744\u201354.","journal-title":"Respir Med"},{"issue":"3","key":"3947_CR12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0213728","volume":"14","author":"AN Aggarwal","year":"2019","unstructured":"Aggarwal AN, Agarwal R, Sehgal IS, Dhooria S. Adenosine deaminase for diagnosis of tuberculous pleural effusion: a systematic review and meta-analysis. PLoS One. 2019;14(3):e0213728.","journal-title":"PLoS One"},{"issue":"5","key":"3947_CR13","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1097\/MAJ.0000000000000260","volume":"348","author":"SJ Lee","year":"2014","unstructured":"Lee SJ, Kim HS, Lee SH, Lee TW, Lee HR, Cho YJ, et al. Factors influencing pleural adenosine deaminase level in patients with tuberculous pleurisy. Am J Med Sci. 2014;348(5):362\u20135.","journal-title":"Am J Med Sci"},{"key":"3947_CR14","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1186\/1471-2334-13-546","volume":"13","author":"TR Tay","year":"2013","unstructured":"Tay TR, Tee A. Factors affecting pleural fluid adenosine deaminase level and the implication on the diagnosis of tuberculous pleural effusion: a retrospective cohort study. BMC Infect Dis. 2013;13:546.","journal-title":"BMC Infect Dis"},{"key":"3947_CR15","unstructured":"Guisti G, Galanti B. Adenosine deaminase colorimetric method. Methods of enzymatic analysis. 5th ed. New York: Academic Press; 1984. p. 315\u2013323."},{"issue":"7","key":"3947_CR16","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1007\/s00134-003-1761-8","volume":"29","author":"JE Fischer","year":"2003","unstructured":"Fischer JE, Bachmann LM, Jaeschke R. A readers\u2019 guide to the interpretation of diagnostic test properties: clinical example of sepsis. Intensive Care Med. 2003;29(7):1043\u201351.","journal-title":"Intensive Care Med"},{"issue":"5","key":"3947_CR17","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.ejim.2010.03.011","volume":"21","author":"JM Porcel","year":"2010","unstructured":"Porcel JM, Esquerda A, Bielsa S. Diagnostic performance of adenosine deaminase activity in pleural fluid: a single-center experience with over 2100 consecutive patients. Eur J Intern Med. 2010;21(5):419\u201323.","journal-title":"Eur J Intern Med"},{"issue":"6","key":"3947_CR18","doi-asserted-by":"publisher","first-page":"787","DOI":"10.5588\/ijtld.12.0892","volume":"17","author":"SA Sahn","year":"2013","unstructured":"Sahn SA, Huggins JT, San Jose ME, Alvarez-Dobano JM, Valdes L. Can tuberculous pleural effusions be diagnosed by pleural fluid analysis alone? Int J Tuberc Lung Dis. 2013;17(6):787\u201393.","journal-title":"Int J Tuberc Lung Dis"},{"issue":"9","key":"3947_CR19","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1016\/j.jclinepi.2005.01.016","volume":"58","author":"JJ Deeks","year":"2005","unstructured":"Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58(9):882\u201393.","journal-title":"J Clin Epidemiol"},{"key":"3947_CR20","doi-asserted-by":"crossref","unstructured":"Blakiston M, Chiu W, Wong C, Morpeth S, Taylor S. Diagnostic Performance of Pleural Fluid Adenosine Deaminase for Tuberculous Pleural Effusion in a Low-Incidence Setting. J Clin Microbiol. 2018;56(8). Epub 2018\/05\/26.","DOI":"10.1128\/JCM.00258-18"},{"issue":"6","key":"3947_CR21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0038729","volume":"7","author":"A Garcia-Zamalloa","year":"2012","unstructured":"Garcia-Zamalloa A, Taboada-Gomez J. Diagnostic accuracy of adenosine deaminase and lymphocyte proportion in pleural fluid for tuberculous pleurisy in different prevalence scenarios. PLoS One. 2012;7(6):e38729.","journal-title":"PLoS One"},{"key":"3947_CR22","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiochem.2023.110655","volume":"120","author":"Y Liu","year":"2023","unstructured":"Liu Y, Huang W, Yang J, Yuan S, Li C, Wang W, et al. Construction of a multi-classified decision tree model for identifying malignant pleural effusion and tuberculous pleural effusion. Clin Biochem. 2023;120:110655.","journal-title":"Clin Biochem"},{"key":"3947_CR23","doi-asserted-by":"crossref","unstructured":"Shimoda M, Tanaka Y, Morimoto K, Yoshiyama T, Yoshimori K, Ohta K. Diagnostic flowchart for tuberculous pleurisy, pleural infection, and malignant pleural effusion. Respir Investig. 2024;62(1):157\u201363 (Epub 2023\/12\/24).","DOI":"10.1016\/j.resinv.2023.11.005"},{"issue":"13","key":"3947_CR24","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2025.40.e35","volume":"40","author":"J Lee","year":"2025","unstructured":"Lee J, Park J, Lim JK, Park JE, Lee YH, Choi SH, et al. Tuberculous and malignant pleural effusions with adenosine deaminase levels of 40\u201370 IU\/L: trends in new cases over time and differentiation between groups. J Korean Med Sci. 2025;40(13):e35.","journal-title":"J Korean Med Sci"},{"key":"3947_CR25","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiochem.2023.110655","volume":"120","author":"Y Liu","year":"2023","unstructured":"Liu Y, Huang W, Yang J, Yuan S, Li C, Wang W, et al. Construction of a multi-classified decision tree model for identifying malignant pleural effusion and tuberculous pleural effusion. Clin Biochem. 2023;120:110655.","journal-title":"Clin Biochem"},{"issue":"1","key":"3947_CR26","doi-asserted-by":"publisher","first-page":"137","DOI":"10.3904\/kjim.2020.246","volume":"37","author":"J Lee","year":"2022","unstructured":"Lee J, Park JE, Choi SH, Seo H, Lee SY, Lim JK, et al. Laboratory and radiological discrimination between tuberculous and malignant pleural effusions with high adenosine deaminase levels. Korean J Intern Med. 2022;37(1):137\u201345.","journal-title":"Korean J Intern Med"},{"issue":"1","key":"3947_CR27","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s12890-020-1049-6","volume":"20","author":"SB Kim","year":"2020","unstructured":"Kim SB, Shin B, Lee JH, Lee SJ, Kim SH. Pleural fluid ADA activity in tuberculous pleurisy can be low in elderly, critically ill patients with multi-organ failure. BMC Pulm Med. 2020;20(1):13.","journal-title":"BMC Pulm Med"},{"key":"3947_CR28","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.tube.2018.11.004","volume":"114","author":"P Korczynski","year":"2019","unstructured":"Korczynski P, Klimiuk J, Safianowska A, Krenke R. Impact of age on the diagnostic yield of four different biomarkers of tuberculous pleural effusion. Tuberculosis (Edinb). 2019;114:24\u20139.","journal-title":"Tuberculosis (Edinb)"},{"issue":"4","key":"3947_CR29","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1183\/09031936.96.09040747","volume":"9","author":"L Valdes","year":"1996","unstructured":"Valdes L, San Jose E, Alvarez D, Valle JM. Adenosine deaminase (ADA) isoenzyme analysis in pleural effusions: diagnostic role, and relevance to the origin of increased ADA in tuberculous pleurisy. Eur Respir J. 1996;9(4):747\u201351.","journal-title":"Eur Respir J"}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-025-03947-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-025-03947-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-025-03947-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:02:39Z","timestamp":1761609759000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpulmmed.biomedcentral.com\/articles\/10.1186\/s12890-025-03947-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,27]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["3947"],"URL":"https:\/\/doi.org\/10.1186\/s12890-025-03947-9","relation":{},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,27]]},"assertion":[{"value":"10 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Medical Ethics Committee of Shanghai Pulmonary Hospital (No.: K25-501), with strict adherence to the principles of the Declaration of Helsinki. A written informed consent was obtained from the patients.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"492"}}