Jalal Mohsin Uddin1, Md. Ali Hossain2, Md. Khairul Hassan Jessy3, Selina Akter4 Syed Rezaul Huq5, Md.Khairul Anam5, Nirmal Kanti Sarkar6, Md. Mamunur Rashid6
Abstract:
Background : Pleural effusions often create a dilemma in clinical practice,especially in terms of distinguishing between tubercular and malignant causes.Conventional methods are not always capable of establishing the cause of pleural effusion; that is why alternative and less invasive tests are greatly needed for rapid and accurate diagnosis. At the same time it should be cost effective and easily available. A variety of biological markers have been proposed, among them either C- reactive protein (CRP) or ADA may be the best alternative for the analysis of pleural fluid . Aim : To select a better
biological marker between ADA and CRP for differentiation of malignant and tubercular pleural effusion. Methods : This was a crass sectional study,was carried out in the department of respiratory medicine and thoracic surgery of National Institute of Diseases of Chest and Hospital (NIDCH) ,Dhaka , during the period of July 2010 to June 2011 . 216 patients were enrolled consecutively. Pleural effusion was collected from each patient ,CRP and ADA were measured , after that they were followed up till their diagnosis were reached . Among them 85 cases of tubercular pleural effusion
and 69 cases of malignant pleural effusions were put into analysis.
Histologically proven tubercular granuloma and malignancy were considered as gold standard. Results: Majority of the patients with malignant disease had low level of CRP, 62.32% at the level of <6 / 6 U/L and below 24 U/L was 79.91%, on the other hand in patients with TB have high level of CRP. 85.88% tubercular pleural effusion having CRP level e” 24 U/L. Majority of the patients (41 among 69) with malignancy have low level of ADA (<40U/L) and on the other hand among 85 patients having tuberculosis, 80 patients have ADA level e”40 U/L .Mean of level of CRP is higher (33.38) in TB patient than the mean of CRP level of malignant pleural effusion (11.47) in
respect of all age and sex . Mean level of ADA in tubercular pleural effusion is 85.79 and it is 41.67 in malignant pleural effusion . It was found that where ADA was high there CRP was also high . The sensitivity, specificity, PPV,NPV, LR+, LR-, PTP and accuracy of CRP for detection of tubercular pleural effusion were 83.5%, 79.4%, 83.5%, 79.4%, 4.057, 0.207, 83% and 81.7% respectively. On the other hand the sensitivity, specificity, PPV,NPV, LR+, LR-, PTP and accuracy of ADA for detection of tubercular pleural effusion