Clinical Importance of Angiogenic Cytokines, Fibrinolytic Activity and Effusion Size in Parapneumonic Effusions

Abstract

ObjectiveTo investigate the relationship among angiogenic cytokines, fibrinolytic activity and effusion size in parapneumonic effusion (PPE) and their clinical importance.MethodsFrom January 2008 through December 2010, 26 uncomplicated (UPPE) and 38 complicated (CPPE) PPE were studied. Based on chest ultrasonography, there were non-loculated in 30, uni-loculated in 12, and multi-loculated effusions in 22 patients. The effusion size radiological scores, and effusion vascular endothelial growth factor (VEGF), interleukin (IL)-8, plasminogen activator inhibitor type-1 (PAI-1) and tissue type plasminogen activator (tPA) were measured on admission. Treatment outcome and pleural fibrosis, defined as radiological residual pleural thickening (RPT), were assessed at 6-month follow-up.ResultsThe effusion size and effusion VEGF, IL-8 and PAI-1/tPA ratio were significantly higher in CPPE than in UPPE, and significantly higher in multi-loculated PPE than in non-locualted and uni-loculated PPE, respectively. VEGF (cutoff value 1975 pg/ml) and IL-8 (cutoff value 1937 pg/ml) seemed best to discriminate between UPPE and CPPE. VEGF, IL-8 and effusion size correlated positively with PAI-1/tPA ratio in both UPPE and CPPE. Moreover, the level of VEGF, but not IL-8, correlated positively with effusion size in all patients (r = 0.79, p<0.001) and in UPPE (r = 0.64, p<0.001) and CPPE (r = 0.71, p<0.001) groups. The patients with higher VEGF or greater effusion were prone to have medical treatment failure (n = 10; VEGF, odds ratio 1.01, p = 0.02; effusion size, odds ratio 1.26, p = 0.01). Additionally, ten patients with RPT had larger effusion size and higher levels of VEGF and PAI-1/tPA ratio than did those without.ConclusionsIn PPE, VEGF and IL-8 levels are valuable to identify CPPE, and higher VEGF level or larger effusion is associated with decreased fibrinolytic activity, development of pleural loculation and fibrosis, and higher risk of medical treatment failure.

Lipoteichoic acid upregulates plasminogen activator inhibitor‐1 expression in parapneumonic effusions

“…Previous studies showed that PAI‐1 concentrations are significantly higher in complicated PPE than in uncomplicated PPE, and substantially increased in PPE with RPT than those without, indicating that PAI‐1 affects clinical outcome and is implicated in fibrotic sequel of PPE. Our results further demonstrated that PAI‐1 level was substantially higher in culture‐positive PPE, either GPB or GNB, than CN PPE.…”

“…In response to infections, PMC elaborate plasminogen activator inhibitor (PAI)‐1 to inactivate plasminogen activators and inhibit fibrinolysis, resulting in fibrin deposition, pleural loculation and fibrosis . Previous studies reported that PAI‐1 level is significantly higher in complicated PPE than in uncomplicated PPE and is associated with residual pleural thickening (RPT) …”

“…3,4 Previous studies reported that PAI-1 level is significantly higher in complicated PPE than in uncomplicated PPE and is associated with residual pleural thickening (RPT). 5,6…”

Bronchial cytokine level changes in lung cancer operations

“…Even in cases in which the inflammatory agent does not exist, as in our study, the bronchial IL-8 levels can remain high. Furthermore, in a study by Chung et al [26] the pleural IL-8 levels of complicated parapneumonic effusions were higher than for non-complicated effusions. Another explanation for the elevated IL-8 levels is that that the inflammatory agent might cause systemic inflammation and increased levels of IL-8 in the blood as it passes into the contralateral bronchial system.…”

Empyema and Cavitation After Dental Procedure

“…Host factors predisposing patients to empyema include pneumonia and parapneumonic effusions, as well as contiguous infections of the esophagus, mediastinum, and subdiaphragmatic areas [7,8]. Pleural effusions are nutritionally rich culture media in which WBC defenses are severely impaired [9].…”