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Original Research: DISORDERS OF THE PLEURA |

Proinflammatory and Antiinflammatory Cytokine Levels in Complicated and Noncomplicated Parapneumonic Pleural EffusionsCytokine Profile in Parapneumonic Effusion

Evaldo Marchi, MD, FCCP; Francisco S. Vargas, MD; Milena M. Acencio, BS; Rosa M. S. Sigrist, MD; Marjourie D. A. Biscaro, MD; Leila Antonangelo, MD; Lisete R. Teixeira, MD, FCCP; Richard W. Light, MD, FCCP
Author and Funding Information

From the Pulmonary Division (Drs Marchi, Vargas, Antonangelo, and Teixeira and Ms Acencio), Heart Institute (InCor), University of São Paulo Medical School; the JundiaíMedical College (Drs Marchi, Sigrist, and Biscaro), São Paulo, Brazil; and Vanderbilt University (Dr Light), Nashville, TN.

Correspondence to: Evaldo Marchi, MD, FCCP, Pleura Laboratory, University of São Paulo Medical School, Pulmonary Division, Heart Institute (Incor), and Medical College of Jundiaí, Alameda das Castanheiras, 196-Cd. Terras de São Carlos, Jundiaí-13.216-770, São Paulo, Brazil; e-mail: evmarchi@uol.com.br


Funding/Support: Supported by the Foundation to Support Research from the State of São Paulo, Brazil (FAPESP) [Grant 55.599-8].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(1):183-189. doi:10.1378/chest.10-3181
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Objectives:  This study aimed to evaluate a panel of proinflammatory and antiinflammatory cytokines in noncomplicated and complicated parapneumonic pleural effusions and to correlate their levels with pleural fluid biochemical parameters.

Methods:  Serum and pleural effusion were collected from 60 patients with noncomplicated (n = 26) or complicated (n = 34) parapneumonic effusions and assayed for cytologic, biochemical, and proinflammatory and antiinflammatory cytokines. Student t test was used to compare serum and pleural fluid values, Spearman correlation to analyze the relationship between pleural fluid cytokines and biochemical parameters, and accuracy of pleural fluid cytokine levels to determine the optimal cutoff value for identification of complicated effusions. Corrections for multiple comparisons were applied and a P value < .05 was accepted as significant.

Results:  Serum and pleural fluid cytokine levels of IL-8, vascular endothelial growth factor (VEGF), IL-10, and tumor necrosis factor (TNF) soluble receptor (sR) II were similar between groups. In contrast, complicated effusions had higher levels of pleural fluid IL-1β, IL-1 receptor antagonist (ra), and TNF sRI. Negative correlations were found between pleural fluid glucose with IL-1β and TNF sRI and positive correlations between lactic dehydrogenate (LDH) with IL-1β, IL-8, and VEGF. Pleural fluid levels of IL-1β, IL-1ra, and TNF sRI were more accurate than IL-8, VEGF, IL-10, and TNF sRII in discriminating complicated effusions.

Conclusions:  Both proinflammatory and antiinflammatory cytokine levels in pleural fluid are elevated in complicated in comparison with noncomplicated parapneumonic pleural effusions, and they correlate with both pleural fluid glucose and LDH levels. IL-1β, IL-1ra, and TNF sRI had higher sensitivity and specificity than IL-8, VEGF, IL-10, and TNF sRII in discriminating complicated effusions.


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