Ascitic fluid adenosine deaminase insensitivity in detecting tuberculous peritonitis in the United States

• Published in: Hepatology (Baltimore, Md.) Vol. 24; no. 6; pp. 1408 - 1412
• Main Authors: Hillebrand, D J, Runyon, B A, Yasmineh, W G, Rynders, G P
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.12.1996
• Subjects: Adenosine Deaminase - analysis; Ascites - enzymology; Ascites - etiology; Blood Proteins - analysis; Clinical Enzyme Tests; Developing Countries; False Positive Reactions; Humans; Leukocyte Count; Liver Cirrhosis - diagnosis; Liver Cirrhosis - physiopathology; Peritonitis, Tuberculous - diagnosis; Peritonitis, Tuberculous - physiopathology; Prospective Studies; Retrospective Studies; Sensitivity and Specificity; United States; United States
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.510240617

Tuberculous peritonitis, although common in Third World countries, remains an uncommon cause of ascites in the United States. Ascitic fluid adenosine deaminase (ADA) activity has been proposed as a useful diagnostic test. The aim of this retrospective study was to determine the clinical utility of ascitic fluid ADA activity in diagnosing tuberculous peritonitis in a U.S. patient population. A total of 368 ascitic fluid specimens from a well‐characterized ascitic fluid bank, including tuberculous peritonitis (n = 7), tuberculous peritonitis in the setting of cirrhosis (n = 10), and consecutive specimens of widely varied etiologies (n = 351) were analyzed for ADA activity by ultraviolet spectrophotometry at 265 nm. The overall sensitivity of the ADA determination in diagnosing tuberculous peritonitis was only 58.8%, and the specificity was 95.4%. The accuracy of ADA determination (93.8%) compared favorably with that of the common ascitic fluid tests of white blood cell (WBC) count (>500/mm3), total protein (>2.5 g/dL), and combined WBC count and total protein (45.8%, 74.4%, and 81.3%, respectively). However, ADA was only 30% sensitive in detecting tuberculous peritonitis in the setting of cirrhosis, and cirrhosis was present in 59% of the tuberculous peritonitis patients in our population. In addition, malignancy‐related ascites (13%) and bacterial peritonitis specimens (5.8%) occasionally yielded false‐positive results. In conclusion, our results indicate that the ascitic fluid ADA activity has good accuracy but poor sensitivity and imperfect specificity in a U.S. patient population in which the prevalence of tuberculosis is low and underlying cirrhosis is common.