Pleural fluid interleukin‐8 and C‐reactive protein for discriminating complicated non‐purulent from uncomplicated parapneumonic effusions

Porcel, José M.; Galindo, Carlos; Esquerda, Aureli; Trujillano, Javier; Ruiz-González, Agustı́n; Falguera, Miquel; Vives, Manuel

doi:10.1111/j.1440-1843.2007.01189.x

Cited by 34 publications

(23 citation statements)

References 20 publications

(22 reference statements)

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“…Indeed, a number of studies provide support for the use of CRP as a diagnostic aid in tuberculous pleuritis; low pleural CRP levels (,30 mg?L -1 ) make this diagnosis unlikely while being more indicative of a malignancy in patients with exudates [8][9][10]. In addition, our findings complement the scarce previous literature on the application of CRP for identifying CPPE [11,12]. This biomarker emerged as an independent predictor of nonpurulent CPPE in the multivariate analysis, although its adjusted LR+ was lower than those for glucose and LBP.…”

Section: Discriminating Ppe From Other Aetiologiessupporting

confidence: 70%

Biomarkers of infection for the differential diagnosis of pleural effusions

Porcel

Vives²,

Cao³

et al. 2009

European Respiratory Journal

103

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We aimed to investigate whether pleural fluid concentrations of biomarkers for bacterial infection, namely triggering receptor expressed on myeloid cells (sTREM-1), procalcitonin (PCT), lipopolysaccharide-binding protein (LBP) and C-reactive protein (CRP), might identify infectious effusions and discriminate between complicated (CPPEs) and uncomplicated parapneumonic effusions (UPPEs).Stored pleural fluid samples from 308 patients with different causes of pleural effusion were used to measure the four biomarkers. Receiver-operating characteristic analysis determined the accuracy of the new tests.Median pleural fluid levels of CRP, sTREM-1 and LBP were significantly higher in CPPE compared with those in other aetiologies. The area under the curve for distinguishing infectious (parapneumonics and tuberculosis) from noninfectious effusions was 0.87 for CRP, 0.86 for sTREM-1, 0.57 for PCT and 0.87 for LBP. Regarding the discrimination of nonpurulent CPPE versus UPPE, a multivariate analysis found that pleural fluid glucose f60 mg?dL -1 , LBP o17 mg?mL -1 and CRP o80 mg?L -1 were the best parameters. Individually, none of the new biomarkers achieved better performance characteristics than pH, glucose or lactate dehydrogenase in labelling CPPE.In conclusion, elevated pleural fluid levels of CRP, sTREM and LBP identify patients with infectious effusions, particularly those with CPPE. PCT has no value for the differential diagnosis of pleural effusions.

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Section: Discriminating Ppe From Other Aetiologiessupporting

confidence: 70%

Biomarkers of infection for the differential diagnosis of pleural effusions

Porcel

Vives²,

Cao³

et al. 2009

European Respiratory Journal

103

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“…In a logistic regression analysis [17] that included classical pleural fluid biochemistries, TNFa at a cutoff of 80 pg/ml was the most useful diagnostic indicator for CPPE (adjusted likelihood ratios þ 7.6). Likewise, in a comparative study [18] between UPPP and CPPE, pleural fluid levels of IL-8 exhibited good discriminative properties (AUC 0.87).…”

Section: Proinflammatory Cytokinesmentioning

confidence: 90%

Pleural fluid tests to identify complicated parapneumonic effusions

Porcel

2010

Current Opinion in Pulmonary Medicine

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“…The increasing numbers of inflammatory cells within the pleural space lead to a rise in lactate dehydrogenase [77], often in excess of three times the upper limit of normal. A recent report has demonstrated that pleural fluid IL-8 can be an accurate discriminator of complicated and uncomplicated parapneumonic effusion [78], although the same report also demonstrated that pleural fluid pH was equivalent to IL-8 in such discrimination. As a result, pH remains the most useful in defining the need for pleural drainage [14,79].…”

Section: Thoracocentesismentioning

confidence: 97%

Empyema thoracis: new insights into an old disease

Brims

Lansley²,

Waterer³

et al. 2010

European Respiratory Review

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Pleural infection is a disease of historical importance and is still a modern menace, with incidences rising in adults and children, and a significant mortality in adults. Basic research is hampered by limitations with in vivo models, and the bacteriology of empyema is complex. The role of thoracic ultrasound in guiding investigation and drainage of empyema is clear. Prompt treatment with appropriate systemic antibiotics and chest tube drainage are the key; in cases of failure of these measures, thoracic surgery is of proven efficacy in the treatment of this age-old disease.

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Pleural fluid interleukin‐8 and C‐reactive protein for discriminating complicated non‐purulent from uncomplicated parapneumonic effusions

Abstract: Pleural fluid IL-8 is an accurate marker for the identification of non-purulent CPPE.

Cited by 34 publications

References 20 publications

Biomarkers of infection for the differential diagnosis of pleural effusions

Biomarkers of infection for the differential diagnosis of pleural effusions

Pleural fluid tests to identify complicated parapneumonic effusions

Empyema thoracis: new insights into an old disease

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