Diagnostic Accuracy of Cerebrospinal Fluid (CSF) Adenosine Deaminase (ADA) for Tuberculous Meningitis (TBM) in Adults: A Systematic Review and Meta-Analysis

Tuberculous meningitis is the most serious complication of tuberculosis. Early diagnosis is crucial to start relevant treatment to prevent death and disability. Electronic databases PubMed, Google Scholar, and Cochrane Library were used to find relevant articles from January 1980 to June 2022. The r...

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Published in:Curēus (Palo Alto, CA) CA), 2023-06, Vol.15 (6), p.e39896-e39896
Main Authors: Prasad, Manoj Kumar, Kumar, Amit, Nalini, Neelam, Kumar, Pramod, Mishra, Brajesh, Lata, Dipti, Ashok, Chanchal, Kumar, Dewesh, Marandi, Sujeet, Kumar, Divakar, Singh, Shreya, Mahajan, Mayank
Format: Article
Language:English
Subjects:
Accuracy
Adenosine
Age groups
Cerebrospinal fluid
Data collection
Diagnostic tests
Drug resistance
Emergency Medicine
HIV
Human immunodeficiency virus
Infectious Disease
Internal Medicine
Medical diagnosis
Meningitis
Meta-analysis
Patients
Search engines
Systematic review
Tuberculosis
White people
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Summary:Tuberculous meningitis is the most serious complication of tuberculosis. Early diagnosis is crucial to start relevant treatment to prevent death and disability. Electronic databases PubMed, Google Scholar, and Cochrane Library were used to find relevant articles from January 1980 to June 2022. The random-effect model in terms of pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence interval was adopted to derive the diagnostic efficacy of cerebrospinal fluid (CSF) adenosine deaminase (ADA) for the diagnosis of tuberculous meningitis (TBM) in adult patients. A total of 22 studies (20 prospective and two retrospective data) have been included in this meta-analysis, having 1927 participants. We perceived acceptable pooled sensitivity, specificity, summary receiver operating characteristics (SROCs), and diagnostic odds ratio (DOR) of 0.85 (95% CI: 0.77-0.90), 0.90 (95% CI: 0.85-0.93), 0.94 (95% CI: 0.91-0.96) and 48 (95% CI: 26-86), respectively, for CSF-ADA for differentiating TBM from non-TBM in adult patients. To ascertain the certainty of evidence for CSF-ADA as a diagnostic marker for TBM, Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) analysis was used. CSF-ADA is an auspicious diagnostic test with a high degree of specificity and acceptable sensitivity for the diagnosis of tuberculous meningitis, however, with very low certainty of evidence.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.39896