Diagnostic Value of Ascitic Fluid Adenosine Deaminase Activity for Diagnosis of Tuberculous Peritonitis

Backgrounds/Aims: The diagnosis of tuberculous peritonitis, particularly in patients with chronic liver disease, is usually difficult since liver cirrhosis obscures the clinical features and alters the biochemical characteristics of ascites. The aim of this retrospective study was to determine the clinical utility of ascitic fluid adenosine deaminase (ADA) activity in diagnosing tuberculous peritonitis. Methods: A total of 111 subjects including pure tuberculous peritonitis (n=16), tuberculous peritonitis superimposed on liver cirrhosis (n=8), liver cirrhosis (n=56), liver cirrhosis with spontaneous bacterial peritonitis (n=11), peritoneal carcinomatosis (n=11) and other etiologies (n=9) were analyzed focusing on ADA activity. Results: The overall sensitivity and specificity of ADA in diagnosing tuberculous peritonitis were 91.7% and 92%, respectively. The accuracy of ADA determination (91.9%) was compared favorably with that of other common ascitic fluid tests. Although absolute ADA activity in 8 patients with tuberculous peritonitis superimposed on liver cirrhosis was lower than that in patients with pure tuberculous peritonitis, all of these patients had higher ADA activities than a cut-off value. Conclusions: ADA activity determination in ascitic fluid is a useful noninvasive test for the diagnosis of tuberculosis and even in the presence of cirrhosis, the sensitivity of this test is not markedly decreased.