Role of ascites adenosine deaminase in differentiating between tuberculous peritonitis and peritoneal carcinomatosis

Table 1 Demographics and clinical characteristics of the patients n (%)

	Tuberculous peritonitis (n = 27)	Peritoneal carcinomatosis (n = 25)	P value
Age (yr)	58.04 ± 12.61	61.12 ± 11.67	0.37
Gender (M:F)	11:16	16:9	0.09
Duration of symptoms			0.01
< 1 mo	11 (40.7)	2 (8.0)
≥ 1 mo	16 (59.3)	23 (92.0)
Symptoms
Abdominal pain	12 (44.4)	15 (60.0)	0.26
Abdominal distension	25 (92.6)	21 (84.0)	0.33
Weight loss	8 (29.6)	11 (44.0)	0.28
Loss of appetite	12 (44.4)	8 (32.0)	0.36
Night sweating	3 (11.1)	0 (0.0)	0.09
Fever	16 (59.3)	0 (0.0)	< 0.01
Diarrhea	2 (7.4)	3 (12.0)	0.58

M/F: Male/female.

Table 2 Laboratory features including tumor markers in serum and ascites of the patients

	Tuberculous peritonitis(n = 27)	Peritoneal carcinomatosis(n = 25)	P value
Serum lab
Serum WBC (/mm3)	6083.7 ± 3115.9	6429.6 ± 2466.6	NS
Serum lymphocyte (%)	16.70 ± 8.39	22.01 ± 7.19	0.02
Serum CRP (mg/dL)	7.88 ± 6.62	3.12 ± 2.69	0.03
Serum CEA (ng/mL)	1.79 ± 1.09	10.26 ± 25.38	0.02
Serum CA 19-9 (U/mL)	10.63 ± 8.52	2283.56 ± 6211.99	0.05
Serum CA 125 (U/mL)	591.36 ± 440.95	676.73 ± 1088.28	NS
Ascites lab
Ascites WBC (/mm3)	1325.9 ± 955.1	951.1 ± 773.1	NS
Ascites lymphocyte (%)	67.77 ± 23.41	48.36 ± 18.78	< 0.01
Ascites albumin (g/dL)	2.30 ± 0.75	2.32 ± 0.76	NS
SAAG	0.72 ± 0.49	1.05 ± 0.50	0.03
Ascites ADA (IU/L)	66.76 ± 32.09	13.89 ± 8.95	< 0.01
Ascites CEA (ng/mL)	1.36 ± 0.83	682.77 ± 1955.34	0.01
Ascites CA 19-9 (U/mL)	17.53 ± 24.15	12344.10 ± 33569.78	NS
Ascites CA 125 (U/mL)	1069.20 ± 578.74	1188.56 ± 1439.06	NS

WBC: White blood cells; CRP: C-reactive protein; CEA: Carcinoembryonic antigen; CA 19-9: Carbohydrate antigen 19-9; CA 125: Carbohydrate antigen 125; SAAG: Serum-ascites albumin gradient; ADA: Adenosine deaminase; NS: Not significant. All statistical significance tests were performed by Mann-Whitney U-test.

Table 3 Abdominal computed tomography characteristics of the patients n (%)

	Tuberculous peritonitis(n = 27)	Peritoneal carcinomatosis(n = 25)	P value
Ascites loculation	11 (40.7)	10 (40.0)	0.96
Parietal involvement			0.04
No	2 (7.4)	3 (12.0)
Smooth thickening	21 (77.8)	10 (40.0)
Irregular or nodular	4 (14.8)	11 (44.0)
Seeding nodule	0 (0.0)	1 (4.0)
Mesenteric change	23 (85.2)	17 (68.0)	0.14
Thickening of mesentery	15 (55.6)	8 (32.0)	0.09
Mesenteric nodule			0.31
No	15 (55.6)	12 (48.0)
Micronodule	12 (44.4)	10 (40.0)
Macronodule	0 (0.0)	2 (8.0)
Omental thickness (mm)	20.48 ± 11.03	23.00 ± 15.77	0.51
Omental change			0.56
No	2 (7.4)	2 (8.0)
Smudged	8 (29.6)	4 (16.0)
Nodular	3 (11.1)	2 (8.0)
Omental cake	13 (48.1)	17 (68.0)
Intestinal involvement	3 (11.1)	5 (20.0)	0.53

Table 4 Peritoneoscopic findings of the patients n (%)

	Tuberculous peritonitis(n = 27)	Peritoneal carcinomatosis(n = 25)	P value
Nodules on peritoneum			< 0.01
No	7 (25.9)	7 (28.0)
< 1 cm micronodule	20 (74.1)	8 (32.0)
> 1 cm macronodule	0 (0.0)	9 (36.0)
Peritoneum			0.41
Multiple whitish patches on parietal peritoneum	2 (7.4)	5 (20.0)
Multiple whitish patches on parietal and visceral peritoneum	0 (0.0)	1 (4.0)
No patches	19 (70.4)	15 (60.0)
Whitish plaques	4 (14.8)	3 (12.0)
Adhesion	14 (51.9)	10 (40.0)	0.41

Table 5 Discriminative capability of tumor markers and adenosine deaminase between tuberculosis peritonitis and peritoneal carcinomatosis using receiver operating characteristics curve

	AUC	95% CI	P value
Serum CRP	0.705	0.537-0.872	0.033
Serum CEA	0.721	0.562-0.880	0.017
Serum CA 19-9	0.693	0.527-0.860	0.044
Ascites ADA	0.966	0.916-1.000	< 0.001
Ascites CEA	0.823	0.686-0.960	0.002

ADA: Adenosine deaminase; CI: Confidence interval; CRP: C-reactive protein; CEA: Carcinoembryonic antigen; CA 19-9: Carbohydrate antigen 19-9; AUC: Area under the curve.