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Original Research: Diseases of the Pleura |

Longitudinal Measurement of Pleural Fluid Biochemistry and Cytokines in Malignant Pleural Effusions

Rajesh Thomas, MBBS; Hui Min Cheah, BSc; Jenette Creaney, PhD; Berwin A. Turlach, PhD; Y. C. Gary Lee, MBChB, PhD, FCCP
Author and Funding Information

Dr Thomas and Ms Cheah contributed equally to this article.

FUNDING/SUPPORT: Dr Lee is a National Health and Medical Research Council (NH&MRC) Career Development Fellow and receives research project grant funding from the NH&MRC, New South Wales Dust Diseases Board, Sir Charles Gairdner Research Advisory Committee, Westcare and the Cancer Council of Western Australia. Dr Thomas has received research scholarship support from NH&MRC, WA Cancer and Palliative Care Network and the Institute of Respiratory Health. Ms Cheah has received postgraduate research scholarships from the University of Western Australia and the Institute of Respiratory Health. Dr Creaney receives research project grant funding from the NH&MRC, New South Wales Dust Diseases Board, Sir Charles Gairdner Research Advisory Committee and the Cancer Council of Western Australia.

CORRESPONDENCE TO: Y. C. Gary Lee, MBChB, PhD, FCCP, School of Medicine and Pharmacology, University of Western Australia, 5th Floor, Harry Perkins Institute of Medical Research, QEII Medical Centre, Perth, WA 6009, Australia


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(6):1494-1500. doi:10.1016/j.chest.2016.01.001
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Background  Malignant pleural effusion (MPE) is common. Existing literature on pleural fluid compositions is restricted to cross-sectional sampling with little information on longitudinal changes of fluid biochemistry and cytokines with disease progression. Indwelling pleural catheters provide the unique opportunity for repeated sampling and longitudinal evaluation of MPE, which may provide insight into tumor pathobiology.

Methods  We collected 638 MPE samples from 103 patients managed with indwelling pleural catheters over 95 days (median, range 0-735 days) and analyzed them for protein, pH, lactate dehydrogenase, and glucose levels. Peripheral blood was quantified for hematocrit, platelets, leukocytes, protein, and albumin. Cytokine levels (monocyte chemotactic protein [MCP]-1; vascular endothelial growth factor; interleukin-6, -8, and -10; tumor necrosis factor-α; and interferon-gamma) were determined in 298 samples from 35 patients with mesothelioma. Longitudinal changes of all parameters were analyzed using a linear mixed model.

Results  Significant decreases were observed over time in pleural fluid protein by 8 g/L per 100 days (SE, 1.32; P < .0001) and pH (0.04/100 days; SE, 0.02; P = .0203), accompanied by a nonsignificant rise in lactate dehydrogenase. The ratio of pleural fluid to serum protein decreased by 0.06/100 days (SE, 0.02; P = .04). MPEs from mesothelioma (n = 63) had lower pleural fluid glucose (P = .0104) at baseline and a faster rate of decline in glucose (P = .0423) when compared with non-mesothelioma effusions (n = 38). A progressive rise in mesothelioma pleural fluid concentration of [log] MCP-1 ([log] 0.37 pg/mL per 100 days; SE, 0.13; P = .0046), but not of other cytokines, was observed.

Conclusions  MPE fluids become less exudative and more acidic over the disease course. The rise in MCP-1 levels suggests a pathobiological role in MPE.

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