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Pleural fluid interleukin‐8 and C‐reactive protein for discriminating complicated non‐purulent from uncomplicated parapneumonic effusions
Author(s) -
PORCEL José M.,
GALINDO Carlos,
ESQUERDA Aureli,
TRUJILLANO Javier,
RUIZGONZÁLEZ Agustín,
FALGUERA Miquel,
VIVES Manuel
Publication year - 2008
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/j.1440-1843.2007.01189.x
Subject(s) - medicine , pleural effusion , parapneumonic effusion , pleural fluid , receiver operating characteristic , gastroenterology , effusion , cutoff , immunoassay , surgery , immunology , antibody , physics , quantum mechanics
Background and objective: This study was designed to test the hypothesis that measurement of IL‐8 and CRP in pleural fluid could improve the identification of patients with non‐purulent parapneumonic effusions that ultimately require chest tube drainage. Methods: We assessed IL‐8, CRP and three classical parameters (pH, glucose and LDH) in the pleural fluid of 100 patients with parapneumonic effusions. Forty‐nine of these patients had non‐purulent complicated effusions (complicated parapneumonic pleural effusion, CPPE), and 51 had uncomplicated parapneumonic pleural effusions (UPPE). Receiver‐operating characteristic curves were used to assess the sensitivity and specificity of pleural fluid biochemical parameters for differentiating among the two patient groups. IL‐8 production was determined using a commercially available ELISA kit, and CRP was measured by immunoassay. Results: At a cutoff value of 1000 pg/mL, IL‐8 differentiated CPPE from UPPE with a sensitivity of 84% and a specificity of 82%. Likewise, CRP levels were higher in CPPE than in UPPE, and showed 72% sensitivity and 71% specificity at a cutoff value of 80 mg/L. We found that all five pleural fluid tests showed similar diagnostic accuracies when evaluated by receiver‐operating characteristic analysis. However, multivariate analysis indicated that the size of the effusion, as well as pleural fluid pH and IL‐8 concentration, were the best discriminatory parameters, with likelihood ratios of 6.4, 4.4 and 3.9, respectively. Conclusions: Pleural fluid IL‐8 is an accurate marker for the identification of non‐purulent CPPE.