Clinical Investigation| Volume 365, ISSUE 5, P437-442, May 2023

Download started.


Activated partial thromboplastin time as a potential biomarker for the diagnosis of tuberculous pleural effusion

Published:October 21, 2022DOI:



      The aim of this study was to explore the difference in activated partial thromboplastin time (APTT) levels in patients with tuberculous and non-tuberculous pleural effusion (TPE and non-TPE) and its possible mechanism to provide a new direction for the diagnosis of pleural effusion (PE).


      A total of 61 patients diagnosed with tuberculous pleurisy with pleural effusion at Shunde Hospital of Southern Medical University from July 2013 to September 2020 were selected as the observation group (tuberculosis group). Another 89 patients (45 with malignant pleural effusion (MPE) and 44 with parapneumonic pleural effusion (PPE) composed the control group. The adenosine deaminase (ADA) level in pleural fluid and plasma APTT level were measured in the two groups.


      The levels of APTT and ADA in the TPE group were significantly higher than the control group, and were 40.03 (37.00, 42.60) (s) and 55.00 (47.00, 69.25) (U/L) for TPE, 29.50 (25.45, 34.20) (s) and 11.90 (9.15, 19.05) (U/L) for malignant pleural effusion (MPE) and 31.35 (27.43, 35.76) (s) and 15.15 (7.40, 35.00) (U/L) for parapneumonic pleural effusion (PPE), respectively.


      The level of plasma APTT has certain significance in differentiating tuberculous pleural effusion from nontuberculous pleural effusion.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Li M.
        • Wang H.
        • Wang X.
        • et al.
        Diagnostic accuracy of tumor necrosis factor-alpha, interferon-gamma, interlukine-10 and adenosine deaminase 2 in differential diagnosis between tuberculous pleural effusion and malignant pleural effusion[J].
        Journal of Cardiothoracic Surgery. 2014; 9: 118
        • Liu Q.
        • Yu Y.
        • Wang X.
        • et al.
        Diagnostic Accuracy of Interleukin-27 between Tuberculous Pleural Effusion and Malignant Pleural Effusion: A Meta-Analysis[J].
        Respiration. 2018; 95: 469-477
        • Tang Y.
        • Zhang J.
        • Huang H.
        • et al.
        Pleural IFN-γ release assay combined with biomarkers distinguished effectively tuberculosis from malignant pleural effusion[J].
        BMC Infect Dis. 2019; 19
        • Liu Y.
        • Ou Q.
        • Zheng J.
        • et al.
        A combination of the QuantiFERON-TB Gold In-Tube assay and the detection of adenosine deaminase improves the diagnosis of tuberculous pleural effusion[J].
        Emerg Microbes Infect. 2019; 5: 1-6
        • Goto M.
        • Noguchi Y.
        • Koyama H.
        • et al.
        Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis.
        Ann Clin Biochem. 2003; 40: 374-381
        • Greco S.
        • Girardi E.
        • Masciangelo R.
        • et al.
        Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy:a meta-analysis.
        Int J Tuberculos Lung Dis. 2003; 7: 777
        • Gui X.
        • Xiao H.
        Diagnosis of tuberculosis pleurisy with adenosine deaminase (ADA): a systematic review and meta-analysis.
        Int J Clin Exp Med. 2014; 7: 3126
        • Wu Y.
        • Ye Z.
        • Qin S.
        • et al.
        Combined detections of interleukin 27, interferon-g, and adenosine deaminase in pleural effusion for diagnosis of tuberculous pleurisy.
        Chin Med J. 2013; 126: 3215-3221
        • Gui X.
        • Xiao H.
        Diagnosis of tuberculosis pleurisy with adenosine deaminase (ADA): a systematic review and meta-analysis[J].
        Int J Clin Exp Med. 2014; 7: 3126-3135
        • Abrao F.C.
        • de Abreu I R L B.
        • Miyaki D.H.
        • et al.
        Role of adenosine deaminase and the influence of age on the diagnosis of pleural tuberculosis[J].
        The Int J Tuberculosis Lung Dis. 2014; 18: 1363-1369
        • Porcel J.M.
        Advances in the diagnosis of tuberculous pleuritis[J].
        Ann Transl Med. 2016; 4: 282
        • Levy J.H.
        • Szlam F.
        • Wolberg A.S.
        • et al.
        Clinical Use of the Activated Partial Thromboplastin Time and Prothrombin Time for Screening[J].
        Clin Lab Med. 2014; 34: 453-477
        • Xie X.
        • Wang X.
        • Laskowitz D.T.
        • et al.
        Effect of dual versus mono antiplatelet therapy on recurrent stroke modulated by activated partial thromboplastin time[J].
        Eur J Neurol. 2019;
        • Akpan P.A.
        • Akpotuzor J.O.
        • Osim E.E.
        Haemostatic Indices as Markers for Monitoring Pulmonary Tuberculosis Treatment[J].
        Niger J Physiol Sci. 2018; 33: 31-35
        • Verhamme P.
        • Hoylaerts M.F.
        Hemostasis and inflammation: two of a kind?[J].
        Thrombosis J. 2009; 7: 15
        • Jann-Yuan W.
        • Po-Ren H.
        • Li-Na L.
        • et al.
        Mycobacterium tuberculosis inducing disseminated intravascular coagulation[J].
        Thromb Haemost. 2005; 93: 729-734
        • Awodu O.
        • Ajayi I.
        • Famodu A.
        Haemorheological variables in Nigeria pulmonary tuberculosis patients undergoing therapy[J].
        Clin Hemorheol Microcirc. 2007; 36: 267-275
        • Piras M.A.
        • Gakis C.
        • Budroni M.
        • et al.
        Adenosine deaminase activity in pleural effusions: an aid to differential diagnosis[J].
        Br Med J. 1978; 2: 1751-1752
        • Ataullakhanov F.
        • Komarova S.
        • Martynov M.
        • et al.
        A Possible Role of Adenylate Metabolism in Human Erythrocytes 2. Adenylate Metabolism Is Able to Improve the Erythrocyte Volume Stabilization[J].
        J Theor Biol. 1996; 183: 307-316
        • Franco R.
        • Aran J.
        • Colomer D.
        • et al.
        Association of adenosine deaminase with erythrocyte and platelet plasma membrane: an immunological study using light and electron microscopy.[J].
        J Histochem Cytochem. 1990; 38: 653-658
        • Valentine W.
        • Paglia D.
        • Tartaglia A.
        • et al.
        Hereditary Hemolytic Anemia with Increased Red Cell Adenosine Deaminase (45- to 70-fold) and Decreased Adenosine Triphosphate[J].
        Science. 1977; 195: 783-785
        • Chottiner E.
        • Ginsburg D.
        • Tartaglia A.
        • et al.
        Erythrocyte adenosine deaminase overproduction in hereditary hemolytic anemia.[J].
        Blood. 1989; 74: 448-453
        • Hernaningsih Y.
        • Akualing J.S.
        The effects of hemolysis on plasma prothrombin time and activated partial thromboplastin time tests using photo-optical method[J].
        Medicine. 2017; 96: e7976
        • Kitchen S.
        • Geisen U.
        • Kappelmayer J.
        • et al.
        Evaluating the analytical performance of five new coagulation assays for the measurement of prothrombin time and activated thromboplastin time[J].
        Int J Lab Hematol. 2018; 40: 1-9
        • Ma Y.
        • Huh H.
        • Kim S.
        • et al.
        Low intraindividual variability of activated partial thromboplastin time revealed in a population of 10487 control individuals[J].
        Blood Coagul Fibrinolysis. 2013; 24: 746-748