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Tumor Necrosis Factor- in Pleural Fluid^*

A Marker of Complicated Parapneumonic Effusions

^* From the Departments of Internal Medicine (Dr. Porcel) and Clinical Laboratory (Dr. Esquerda), University Hospital Arnau de Vilanova, Lleida; and Division of Internal Medicine (Dr. Vives), Clínica Recoletas, Albacete, Spain.

Correspondence to: José Manuel Porcel, MD, FCCP, Department of Internal Medicine, University Hospital Arnau de Vilanova, Alcalde Rovira Roure 80, 25198 Lleida, Spain; e-mail: jporcelp{at}medynet.com

Study objectives: We sought to determine whether pleural fluid tumor necrosis factor (TNF)- is a more accurate parameter to identify nonpurulent complicated parapneumonic effusion (CPPE) than the classical chemistries, namely pH, glucose, or lactate dehydrogenase (LDH).

Methods: We studied 80 consecutive patients with parapneumonic effusions (35 with uncomplicated parapneumonic effusion [UPPE], 23 with nonpurulent CPPE, and 22 with empyema). Concentrations of standard biochemical parameters together with TNF- were measured in pleural fluid, the latter by using an immunoenzymometric assay.

Results: Pleural TNF- was significantly higher in CPPE (133.0 pg/mL) and empyema (142.2 pg/mL) than in UPPE (39.1 pg/mL). A cut-off value of 80 pg/mL for pleural TNF- resulted in a sensitivity, specificity, and area under receiver operating characteristic curve (AUC) of 78%, 89%, and 0.87, respectively, for the diagnosis of nonpurulent CPPE. A multivariate analysis selected both pleural TNF- 80 pg/mL and LDH 1,000 U/L (sensitivity, 74%; AUC = 0.86), but excluded pleural glucose 60 mg/dL (sensitivity, 39%; AUC = 0.82) and pH 7.20 (sensitivity, 41%; AUC = 0.78), for identifying the need for drainage. The combined sensitivity of pleural fluid TNF- and LDH was found to be 91%.

Conclusions: Pleural TNF- may contribute to the identification of patients with nonpurulent CPPE with at least the same diagnostic accuracy, if not better, than the use of pH, glucose, or LDH.

Key Words: empyema • parapneumonic effusion • tumor necrosis factor • pH • pleural effusion

This article has been cited by other articles:

				G. E. Utine, U. Ozcelik, E. Yalcin, D. Dogru, N. Kiper, A. Aslan, and G. Kanra Childhood Parapneumonic Effusions: Biochemical and Inflammatory Markers Chest, September 1, 2005; 128(3): 1436 - 1441. [Abstract] [Full Text] [PDF]

				M. Odeh, A. Oliven, J. M. Porcel, M. Vives, and A. Esquerda Tumor Necrosis Factor-{alpha} in Parapneumonic Effusion Chest, May 1, 2005; 127(5): 1868 - 1869. [Full Text] [PDF]