Significance of Microbiological and Biochemical Analyses in Empyema Thoracis

Ébert, W.; Hg, Bauer; Bauer, Elke; Trefz, G

doi:10.1055/s-2007-1014047

Cited by 6 publications

(2 citation statements)

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“…Ebert et al [18]described higher PMN-E values in patients with empyema, and Klech et al [19]proved that PMN-E is a marker of pleural inflammation, observing higher values in empyema patients. But it was Castaño and Amores [11]who evaluated the role of elastase in diagnosing PE of infectious origin and reported a diagnostic efficacy, sensitivity and specificity slightly higher than what we obtained.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Pleural Fluid Polymorphonuclear Elastase in the Differentiation between Pyogenic Bacterial Infectious and Non-Infectious Pleural Effusions

Alegre

Suriñach²,

Varela³

et al. 2000

Respiration

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Background and Objectives: To establish the diagnostic accuracy of the markers of neutrophil activity (elastase and lysozyme) determined in pleural fluid, for differentiating between pyogenic bacterial infectious and non-infectious pleural effusions. Patients and Methods: At our tertiary referral teaching hospital, 160 patients over 14 years with pleural effusion (PE), classified as pyogenic bacterial infectious (41 parapneumonic complicated, 32 parapneumonic non-complicated) and non-infectious (32 neoplasm and 55 undiagnosed pleural exudates) were examined in a prospective study. Polymorphonuclear elastase (PMN-E) was determined by an immunoactivation method and lysozyme by a turbidimetric method. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy. Results: Pleural fluid PMN-E was the biochemical marker that best differentiated between pyogenic bacterial infectious and non-infectious PE. The ROC area under the curve (AUC) for PMN-E was 0.8276. A PMN-E value over 230 µg/l diagnosed infectious PE with a specificity of 0.81 and a sensitivity of 0.74. The ROC AUC for proteins plus lactate dehydrogenase was 0.7430. Differences between the two ROC curves were significant (p = 0.032). After excluding purulent parapneumonic complicated PE, the sensitivity of a pleural fluid PMN-E value equal to or greater than 230 µg/l was 0.64 and the specificity 0.81. Conclusions: Pleural fluid PMN-E was the marker that best differentiated infectious from non-infectious PE, and PMN-E values lower than 230 µg/l suggest non-infectious PE.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Pleural Fluid Polymorphonuclear Elastase in the Differentiation between Pyogenic Bacterial Infectious and Non-Infectious Pleural Effusions

Alegre

Suriñach²,

Varela³

et al. 2000

Respiration

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“…It has been shown that PMN-E determination may be useful in the differential diagnosis of pyogenic infectious and noninfectious pleural effusions [7, 8, 9, 10, 11]. …”

Section: Introductionmentioning

confidence: 99%

Polymorphonuclear Elastase in the Early Diagnosis of Complicated Pyogenic Pleural Effusions

Alemán¹,

Alegre²,

Segura³

et al. 2003

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Background: Polymorphonuclear elastase (PMN-E) is a neutrophilic marker that has been implicated in acute inflammatory responses. Objectives: To evaluate the accuracy of PMN-E in the diagnosis of complicated pyogenic effusions. Patients and Method: We studied 536 patients with pleural effusion of various etiologies. There were 125 pyogenic bacterial effusions (42 typical parapneumonic, 17 borderline complicated parapneumonic and 66 complicated parapneumonic or empyema), 83 tuberculous, 91 malignant, 42 paramalignant, 95 transudates, 28 miscellaneous and 72 effusions of unknown origin. Classic markers (pH, glucose, proteins, adenosine deaminase, LDH, leukocytes and differential count) and the PMN-E level were quantified in pleural fluid. The accuracy of PMN-E as an early marker in the diagnosis of complicated pyogenic infectious effusions was evaluated among pleural effusions that were not diagnosed with classic biochemical markers, radiological findings or Gram stain. Since results of pleural fluid culture and cytological examination are generally available after a 48-hour delay, they were not included as early markers in the initial diagnosis of pleural effusions. Results: Early diagnosis of complicated pyogenic bacterial effusions was achieved in only 48 of 66 cases with classic markers. Among those that were not diagnosed with these parameters, a pleural PMN-E value >3,500 µg/l discriminated between complicated and noncomplicated pyogenic bacterial effusions with a sensitivity of 67% and a specificity of 97%. Conclusions: PMN-E is useful in the early diagnosis and management of complicated pyogenic infectious effusions, which may be delayed with classic markers.

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Respiratory Infections

2007

Equine Infectious Diseases

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Significance of Microbiological and Biochemical Analyses in Empyema Thoracis

Cited by 6 publications

References 1 publication

Diagnostic Accuracy of Pleural Fluid Polymorphonuclear Elastase in the Differentiation between Pyogenic Bacterial Infectious and Non-Infectious Pleural Effusions

Diagnostic Accuracy of Pleural Fluid Polymorphonuclear Elastase in the Differentiation between Pyogenic Bacterial Infectious and Non-Infectious Pleural Effusions

Polymorphonuclear Elastase in the Early Diagnosis of Complicated Pyogenic Pleural Effusions

Respiratory Infections

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