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Disorders of the Pleura |

25-Hydroxyvitamin D in Malignant and Nonmalignant Pleural Effusions

Marios Panagiotou, MD; Andriana Papaioannou, MD; Filia Diamantea, MD; Anna Takou, MD; Styliani Giannakaki, MD; Elvira Markela Antonogiannaki, MD; Sofia Pouriki, MD; Alexandros Kalkanis, MD; George Maropoulos, MD; Emmanuel Kastanakis, MD; Vlasis Polychronopoulos, MD; Konstantinos Kostikas, MD; Napoleon Karagianidis, MD
Author and Funding Information

3rd Respiratory Medicine Department, General Hospital of Attiki Sismanoglio-A. Fleming, Athens, Greece


Chest. 2014;145(3_MeetingAbstracts):270A. doi:10.1378/chest.1835589
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Abstract

SESSION TITLE: Pleural Disease/Pleural Effusion Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Serum vitamin D has been associated with the risk of developing lung cancer, degree of histological differentiation, tumor metastatic growth in lung cancer cells, response to chemotherapy and survival. Similar evidence exists for other types of cancer. However, the potential role of vitamin D in malignant pleural disease has not been studied to date. The purpose of this study is to evaluate the diagnostic and prognostic role of Vitamin D in pleural effusions of various etiologies.

METHODS: Prospective study of consecutive patients with a new diagnosis of pleural effusion admitted to a General Hospital, Athens, Greece. Patients were followed-up for 6 months. Exclusion criteria included previous diagnostic or therapeutic attempts or no definite diagnosis within the follow-up period. Pleural fluid and serum samples were collected, protected from light exposure and immediately stored in -80°C until testing for 25-Hydroxyvitamin D (VitD) with electro-chemiluminescence immunoassay (ECLIA).

RESULTS: Fifty patients were studied. Pleural VitD was higher than serum VitD (p<0.001). Pleural VitD did not differ between exudates and transudates (p=0.492) but it was significantly higher in malignant compared to benign effusions (p=0.033). Pleural VitD ≥11.6 ng/ml was diagnostic for malignant effusions (Sensitivity=67%,Specificity=73%,PPV=76%,NPV=63%). Pleural VitD did not differ between malignant effusions caused by lung cancer versus non-lung cancer (p=0.086). Although pleural VitD above the upper quartile (i.e.24.5ng/ml) was not related to survival, serum VitD above the upper quartile (i.e.17.6ng/ml) was related to better survival (p=0.114,p=0.022 respectively, log rank test). Reproducibility of the measurement of pleural VitD was acceptable.

CONCLUSIONS: Malignant pleural effusions present increased levels of VitD compared to non-malignant effusions. Pleural VitD cutoff 11.6 ng/ml was diagnostic for malignant effusions with moderate sensitivity and specificity and good PPV. Increased levels of serum VitD were associated with better survival in this small population. Higher levels of pleural VitD may reflect a greater local immune response or a sequestration of a systemic response in the pleural space.

CLINICAL IMPLICATIONS: Pleural and serum VitD might have a diagnostic and prognostic role in malignant pleural effusions.

DISCLOSURE: The following authors have nothing to disclose: Marios Panagiotou, Andriana Papaioannou, Filia Diamantea, Anna Takou, Styliani Giannakaki, Elvira Markela Antonogiannaki, Sofia Pouriki, Alexandros Kalkanis, George Maropoulos, Emmanuel Kastanakis, Vlasis Polychronopoulos, Konstantinos Kostikas, Napoleon Karagianidis

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