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Original Research 
RMJ. 2026; 51(2): 343-347


Diagnostic accuracy of adenosine deaminase levels in suspected patients of pulmonary tuberculosis in a tertiary care hospital of South Punjab, Pakistan

Afshan Zareen, Lubna Sarfraz, Muhammad Waseem Abbas, Saleha Zafar.


Abstract
Objective: To determine the diagnostic accuracy of adenosine deaminase (ADA) levels in suspected patients of pulmonary tuberculosis (PTB), taking auramine staining as the gold standard.
Methodology: This cross-sectional diagnostic validation study was conducted at the Pathology and Chest Departments of Bahawal Victoria Hospital, Bahawalpur, Pakistan, from October 2024 to July 2025. A total of 133 patients aged 18-75 years with suspected tuberculous pleural effusion were enrolled through non-probability consecutive sampling. Pleural fluid samples were tested for ADA levels, with a cutoff of 60 U/L, and compared against auramine/rhodamine staining as the reference. Data were analyzed in SPSS 26. Diagnostic accuracy indices were calculated, and subgroup analyses were performed. Chi-square and McNemar’s tests assessed association and discordance, with p<0.05 taken as significant.
Results: Among 133 patients, the median age was 43.0 years (IQR 31.0–59.0), with 72 (54.1%) males and 61 (45.9%) females. Body mass index was <25 kg/m² in 104 (78.2%) patients. Tuberculosis contact history was positive in 60 (45.1%), and family history in 62 (46.6%) patients. The mean ADA level was 58.1±11.4 U/L. ADA showed sensitivity 91.9%, specificity 97.2%, PPV 96.6%, NPV 93.2%, and accuracy 94.0% (χ²=106.5, p<0.001, McNemar p=0.453).
Conclusion: ADA in pleural fluid demonstrated high diagnostic accuracy compared with auramine staining.

Key words: Adenosine deaminase, body mass index, Pakistan, pleural effusion, tuberculosis.


 
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How to Cite this Article
Pubmed Style

Zareen A, Sarfraz L, Abbas MW, Zafar S. Diagnostic accuracy of adenosine deaminase levels in suspected patients of pulmonary tuberculosis in a tertiary care hospital of South Punjab, Pakistan. RMJ. 2026; 51(2): 343-347.

Web Style

Zareen A, Sarfraz L, Abbas MW, Zafar S. Diagnostic accuracy of adenosine deaminase levels in suspected patients of pulmonary tuberculosis in a tertiary care hospital of South Punjab, Pakistan. https://www.rmj.org.pk/?mno=281785 [Access: June 23, 2026].

AMA (American Medical Association) Style

Zareen A, Sarfraz L, Abbas MW, Zafar S. Diagnostic accuracy of adenosine deaminase levels in suspected patients of pulmonary tuberculosis in a tertiary care hospital of South Punjab, Pakistan. RMJ. 2026; 51(2): 343-347.


Vancouver/ICMJE Style

Zareen A, Sarfraz L, Abbas MW, Zafar S. Diagnostic accuracy of adenosine deaminase levels in suspected patients of pulmonary tuberculosis in a tertiary care hospital of South Punjab, Pakistan. RMJ. (2026), [cited June 23, 2026]; 51(2): 343-347.


Harvard Style

Zareen, A., Sarfraz, . L., Abbas, . M. W. & Zafar, . S. (2026) Diagnostic accuracy of adenosine deaminase levels in suspected patients of pulmonary tuberculosis in a tertiary care hospital of South Punjab, Pakistan. RMJ, 51 (2), 343-347.


Turabian Style

Zareen, Afshan, Lubna Sarfraz, Muhammad Waseem Abbas, and Saleha Zafar. 2026. Diagnostic accuracy of adenosine deaminase levels in suspected patients of pulmonary tuberculosis in a tertiary care hospital of South Punjab, Pakistan. Rawal Medical Journal, 51 (2), 343-347.


Chicago Style

Zareen, Afshan, Lubna Sarfraz, Muhammad Waseem Abbas, and Saleha Zafar. "Diagnostic accuracy of adenosine deaminase levels in suspected patients of pulmonary tuberculosis in a tertiary care hospital of South Punjab, Pakistan." Rawal Medical Journal 51 (2026), 343-347.


MLA (The Modern Language Association) Style

Zareen, Afshan, Lubna Sarfraz, Muhammad Waseem Abbas, and Saleha Zafar. "Diagnostic accuracy of adenosine deaminase levels in suspected patients of pulmonary tuberculosis in a tertiary care hospital of South Punjab, Pakistan." Rawal Medical Journal 51.2 (2026), 343-347. Print.


APA (American Psychological Association) Style

Zareen, A., Sarfraz, . L., Abbas, . M. W. & Zafar, . S. (2026) Diagnostic accuracy of adenosine deaminase levels in suspected patients of pulmonary tuberculosis in a tertiary care hospital of South Punjab, Pakistan. Rawal Medical Journal, 51 (2), 343-347.


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