Diagnostic test accuracy of adenosine deaminase for tuberculous meningitis: A systematic review and meta-analysis

Introduction: The measurement of adenosine deaminase (ADA) level in cerebrospinal fluid (CSF) has generated as a suitable test for tuberculous meningitis (TBM) diagnosis. The main objective in the present meta-analysis focused on analyzing the ADA test accuracy in order to diagnose TBM. Methods: We searched several databases including Medline, Embase and Cochrane databases to identify studies addressing the diagnosis of TBM. The quality of included reports were assessed by RevMan5 software (via QUADS2 checklist). Accuracy measures of ADA test (sensitivity, specificity and others) pooled with random effects models. In addition, the data was elicited by using midas and metan packages in stata (version 12). Result: Twenty studies were eligible for inclusion within the meta-analysis. The pooled sensitivity and specificity for TBM diagnosis hallmarks were 89% (95% CI: 0.84-0.92) and 91% (95% CI: 0.87-0.93), respectively. The positive likelihood ratio was 9.4 ( 95% CI: 7-12.8), negative likelihood ratio was 0.12 ( 95% CI: 0.09-0.17), and diagnostic odds ratio was 77 ( 95% CI: 45-132). Indeed, the area under the summary receiver operating characteristic (SROC) was 0.96. Conclusion: It was magnificently attained that ADA test had a relatively high accuracy for TBM diagnosis. (C) 2017 Published by Elsevier Ltd on behalf of The British Infection Association.