Association of Serum ADA Levels in Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis
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Issued Date
2026-04-01
Resource Type
ISSN
16617827
eISSN
16604601
Scopus ID
2-s2.0-105036822183
Journal Title
International Journal of Environmental Research and Public Health
Volume
23
Issue
4
Rights Holder(s)
SCOPUS
Bibliographic Citation
International Journal of Environmental Research and Public Health Vol.23 No.4 (2026)
Suggested Citation
Songsri J., Thanasai J., Tangpong J., Chittamma A., Klangbud W.K. Association of Serum ADA Levels in Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health Vol.23 No.4 (2026). doi:10.3390/ijerph23040498 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116493
Title
Association of Serum ADA Levels in Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: The early diagnosis of pulmonary tuberculosis (PTB) remains a global challenge. While serum adenosine deaminase (ADA) has been associated with tuberculosis-related immune activation, its consistency across different regions and laboratory methods remains unclear. This study aims to evaluate group-level differences in serum ADA levels and identify factors influencing these variations. Methods: A systematic search was conducted across PubMed, Embase, and Scopus up to February 2026. A meta-analysis using a random-effects model was performed to calculate the pooled standardized mean difference (SMD), reflecting group-level differences in serum ADA levels between PTB patients and control groups. Results: Thirty-four studies were included. Serum ADA levels were significantly higher in PTB patients compared to healthy controls (SMD = 3.15, 95% CI: [2.51–3.79], p < 0.0001) and other respiratory diseases (SMD = 2.06, 95% CI: [1.38–2.74], p < 0.0001). Subgroup analyses revealed that geographical region and ADA measurement methods did not significantly account for the observed high heterogeneity (I<sup>2</sup> > 95%), indicating that ADA elevation was consistently observed across studies. Conclusions: Serum ADA levels were significantly elevated in patients with PTB, indicating a consistent biological association with disease status. However, given the high heterogeneity and the absence of diagnostic accuracy measures (e.g., sensitivity and specificity), these findings should not be interpreted as evidence of clinical diagnostic performance. Further diagnostic test accuracy studies are required to establish its clinical utility.