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Childhood Parapneumonic Effusions^*

Biochemical and Inflammatory Markers

^* From the Department of Pediatrics (Drs. Utine, Ozcelik, Yalcin, Dogru, Kiper, and Aslan), Division of Chest Diseases, and the Department of Pediatrics (Dr. Kanra), Division of Infectious Diseases, Hacettepe University, Ankara, Turkey.

Correspondence to: G. Eda Utine, MD, Hacettepe University, Department of Pediatrics, Division of Genetics, 06100, Shhiye, Ankara, Turkey; e-mail: geutine{at}hacettepe.edu.tr

Study objectives: Biochemical and inflammatory markers in pleural inflammation were evaluated in pediatric cases of parapneumonic effusions, and interleukin (IL)-8 and tumor necrosis factor (TNF)- concentrations were tested for possible differentiation of the complicated nature of effusions.

Patients: Twenty-eight patients (12 female) who were admitted to Hacettepe University Childrens’ Hospital over a 2-year period were included in the study.

Measurements: Patients were grouped according to the stage of effusion. Pleural fluid leukocyte count, neutrophil ratio, pH, protein, glucose levels, lactate dehydrogenase (LDH) levels, TNF- levels, IL-8 levels, and nitrite levels were obtained.

Results: Of these patients, 13 had empyema, 10 had complicated parapneumonic effusions (CPEs), and 5 had uncomplicated parapneumonic effusions (UPEs). Protein and glucose levels decreased, leukocyte count, neutrophil ratio, TNF- levels, nitrite levels, and IL-8 levels increased progressively as the stage of the disease progressed. IL-8 levels, but not TNF- and nitrite levels, were statistically different among the groups. IL-8, TNF-, and nitrite levels all correlated positively with each other (all p 0.001), and pH correlated negatively with these markers (all p 0.001). At a cutoff value of 76.6 pg/mL, TNF- discriminated between CPEs and UPEs with a sensitivity of 50%, a specificity of 100%, and an accuracy of 78%. At a cutoff value of 701.6 pg/mL, IL-8 differentiated CPE and UPE with a sensitivity of 80%, a specificity of 80%, and an accuracy of 86%.

Conclusions: Progressive changes in common biochemical markers (ie, pH, and protein, glucose, and LDH levels) are interrelated during stages of pleural inflammation. IL-8 may be used as an alternative marker for discriminating between CPEs and UPEs in pediatric parapneumonic effusions.

Key Words: interleukin-8 • inflammation • nitric oxide • pediatric parapneumonic effusions • tumor necrosis factor-

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