Association between Elevated Pleural Interleukin-33 Levels and Tuberculous Pleurisy

Abstract

BackgroundInterferon-γ (IFN-γ) plays a crucial role in Mycobacterium tuberculosis induced pleural responses. Interleukin (IL)-33 up-regulates the production of IFN-γ. We aimed to identify whether an association between pleural IL-33 levels and tuberculous pleurisy exists and determine its diagnostic value.MethodsPleural IL-33, ST2 (a receptor of IL-33), adenosine deaminase (ADA), and IFN-γ, as well as serum IL-33 and ST2 were measured in 220 patients with pleural effusions (PEs). Patients with malignant (MPEs), parapneumonic (PPEs), tuberculous (TPEs), and cardiogenic (CPEs) pleural effusions were included.ResultsPleural and serum IL-33 levels were highest or tended to be higher in patients with TPEs than in those with other types of PEs. The median pleural fluid-to-serum IL-33 ratio was higher in TPE cases (≥ 0.91) than in other PE cases (≤ 0.56). Pleural IL-33 levels correlated with those of pleural ADA and IFN-γ. However, the diagnostic accuracies of pleural IL-33 (0.74) and pleural fluid-to-serum IL-33 ratio (0.75) were lower than that of ADA (0.95) or IFN-γ (0.97). Pleural ST2 levels in patients with MPEs were higher than in patients with TPEs. Serum ST2 levels did not differ among the groups.ConclusionsWe identified an association between elevated pleural IL-33 levels and tuberculous pleurisy. However, we recommend conventional pleural markers (ADA or IFN-γ) as diagnostic markers of TPE.

Diagnostic role of interleukin -33 in the differentiation of pleural effusions especially tuberculous and malignant effusions

“…In this study, the positive correlations of pleural effusions IL-33 concentrations with the corresponding serum samples of all patients of the study groups (r = 0.677, P < 0.001); moreover, the positive correlation of subgroups; pleural IL33 in tuberculous, malignant and parapneumonic pleural effusion groups with their corresponding serum IL33 level ( r = 0.848, P < 0.001; r = 0.881, P < 0.001; and r = 0.965, P < 0.001) respectively was in agreement with Xuan et al, Lee et al and Li et al, who in their studies found that; the concentrations of IL-33 in the pleural effusions of tuberculous, malignant and parapneumonic groups positively correlated with that of the corresponding serum samples [17, 20, 21]. ,Also, pleural IL-33 was positively correlated with pleural ADA in patients with tuberculous pleural effusions, ( r = 0.38, P < 0.001), Table 3, in accordance to koung et al and Lee et al who demonstrated statistically significant positive correlations between IL-33 levels and ADA [20]. This positive correlation makes the test more reliable in diagnosing tuberculous pleural effusion.…”

Diagnostic Value of Combined Pleural IL-33, ADA and Peripheral T-SPOT.TB for Tuberculous Pleurisy

“…The level of pleural uid IL-33 was positively correlated with pleural effusion ADA and peripheral blood T-SPOT.TB. Lee KS and Xuan WX and other scholars [9,10] found that the level of IL-33 in pleural effusion of patients with tuberculous pleurisy was signi cantly higher than other causes of pleural effusion and serum IL-33 levels, the sensitivity was 78% and 86.96%, speci city was 65% and 90.48% respectively. It was also suggested by Lee KS and other scholars that pleural uid IL-33 level and pleural ADA are signi cantly positively correlated [9].…”

“…Lee KS and Xuan WX and other scholars [9,10] found that the level of IL-33 in pleural effusion of patients with tuberculous pleurisy was signi cantly higher than other causes of pleural effusion and serum IL-33 levels, the sensitivity was 78% and 86.96%, speci city was 65% and 90.48% respectively. It was also suggested by Lee KS and other scholars that pleural uid IL-33 level and pleural ADA are signi cantly positively correlated [9]. Li D and other scholars [8] also showed that the sensitivity of IL-33 in the diagnosis of tuberculous pleurisy was 83.9%, the speci city was 87.3%, and the area under the ROC curve was 0.823.…”

“…The number of T cells secreting interferon-γ (IFN-γ) can be used as an auxiliary method for early diagnosis of tuberculosis [6,7]. Researches [8][9][10] showed that the level of interleukin-33 (IL-33) in pleural uid was signi cantly higher in patients with tuberculous pleurisy than in other causes. Therefore, we speculate that IL-33 may play an important role in the production of tuberculous pleural effusion (TPE).…”

Diagnostic value of combined pleural IL-33, ADA and peripheral T-SPOT.TB for tuberculous pleurisy

“…The number of T cells secreting interferon-γ (IFN-γ) can be used as an auxiliary method for early diagnosis of tuberculosis [6,7]. Researches [8][9][10] showed that the level of interleukin-33 (IL-33) in pleural uid was signi cantly higher in patients with tuberculous pleurisy than in other causes. Therefore, we speculate that IL-33 may play an important role in the production of tuberculous pleural effusion (TPE).…”