STUDY OF DIAGNOSTIC VALUE OF PLEURAL FLUID LYMPHOCYTE/NEUTROPHIL RATIO & ADA LEVELS IN PATIENTS WITH TUBERCULAR PLEURAL EFFUSION.

Background: Tuberculous pleural effusion is traditionally linked to elevated adenosine deaminase (ADA) activity in the pleural fluid. Nonetheless, elevated activity can also transpire in several other ailments, which could potentially compromise the diagnostic efficacy of ADA assessments and reduce their specificity in tuberculosis (TB) diagnosis. The cellular immune response in the pleural cavity, and specifically the activation of T lymphocytes, is reflected in the presence of ADA in pleural fluids. Specific types of leukocytes are generally linked to different disease entities. The current study's goal is to assess how well the lymphocyte/neutrophil ratio and ADA activity work together to diagnose tuberculous pleural effusion. Aim and Objectives: To study the diagnostic value of Lymphocyte/Neutrophil ratio and ADA levels in pleural fluid in patients with tubercular pleural effusion. Materials and Methods: This is a prospective, observational study in which 150 patients with exudative pleural effusion were selected and their pleural fluid was collected for biochemical, cytological examination. ADA and differential cell counts were determined on all samples during the study period of December 2022 to November 2023 Results: At a level of =40 U/L, pleural fluid ADA has the following values: sensitivity = 94.6%, specificity = 94.8%, positive predictive value =96.6%, negative predictive value=91.7%, efficacy= 94.6%. At p-value (< 0.001), it was statistically significant. When the lymphocyte/neutrophil levels are included, they had a sensitivity=96.7%, specificity=100%, positive predictive value=100%, and negative predictive value=95.1% and efficacy=98%, with a ratio of =0.75. Conclusion: When diagnosing tubercular pleural effusion, ADA is a very sensitive diagnostic marker. In patients with tubercular pleural effusion, the combination of pleural fluid ADA and lymphocyte/neutrophil ratio improves diagnostic accuracy more than pleural fluid ADA by itself. [ABSTRACT FROM AUTHOR]