0
Clinical Investigations: PLEURAL |

Tumor Necrosis Factor-α in Pleural Fluid*: A Marker of Complicated Parapneumonic Effusions

José Manuel Porcel; Manuel Vives; Aureli Esquerda
Author and Funding Information

*From the Departments of Internal Medicine (Dr. Porcel) and Clinical Laboratory (Dr. Esquerda), University Hospital Arnau de Vilanova, Lleida; and Division of Internal Medicine (Dr. Vives), Clínica Recoletas, Albacete, Spain.

Correspondence to: José Manuel Porcel, MD, FCCP, Department of Internal Medicine, University Hospital Arnau de Vilanova, Alcalde Rovira Roure 80, 25198 Lleida, Spain; e-mail: jporcelp@medynet.com



Chest. 2004;125(1):160-164. doi:10.1378/chest.125.1.160
Text Size: A A A
Published online

Study objectives: We sought to determine whether pleural fluid tumor necrosis factor (TNF)-α is a more accurate parameter to identify nonpurulent complicated parapneumonic effusion (CPPE) than the classical chemistries, namely pH, glucose, or lactate dehydrogenase (LDH).

Methods: We studied 80 consecutive patients with parapneumonic effusions (35 with uncomplicated parapneumonic effusion [UPPE], 23 with nonpurulent CPPE, and 22 with empyema). Concentrations of standard biochemical parameters together with TNF-α were measured in pleural fluid, the latter by using an immunoenzymometric assay.

Results: Pleural TNF-α was significantly higher in CPPE (133.0 pg/mL) and empyema (142.2 pg/mL) than in UPPE (39.1 pg/mL). A cut-off value of 80 pg/mL for pleural TNF-α resulted in a sensitivity, specificity, and area under receiver operating characteristic curve (AUC) of 78%, 89%, and 0.87, respectively, for the diagnosis of nonpurulent CPPE. A multivariate analysis selected both pleural TNF-α ≥ 80 pg/mL and LDH ≥ 1,000 U/L (sensitivity, 74%; AUC = 0.86), but excluded pleural glucose ≤ 60 mg/dL (sensitivity, 39%; AUC = 0.82) and pH ≤ 7.20 (sensitivity, 41%; AUC = 0.78), for identifying the need for drainage. The combined sensitivity of pleural fluid TNF-α and LDH was found to be 91%.

Conclusions: Pleural TNF-α may contribute to the identification of patients with nonpurulent CPPE with at least the same diagnostic accuracy, if not better, than the use of pH, glucose, or LDH.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543