title: Tumor necrosis factor-alpha in pleural fluid: a marker of complicated parapneumonic effusions.
abstract: OBJECTIVE
  We sought to determine whether pleural fluid tumor necrosis factor (TNF)-alpha 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-alpha were measured in pleural fluid, the latter by using an immunoenzymometric assay.
  
  
  RESULTS
  Pleural TNF-alpha 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-alpha 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-alpha > or = 80 pg/mL and LDH > or = 1,000 U/L (sensitivity, 74%; AUC = 0.86), but excluded pleural glucose < or = 60 mg/dL (sensitivity, 39%; AUC = 0.82) and pH < or = 7.20 (sensitivity, 41%; AUC = 0.78), for identifying the need for drainage. The combined sensitivity of pleural fluid TNF-alpha and LDH was found to be 91%.
  
  
  CONCLUSIONS
  Pleural TNF-alpha 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.
authors.affiliation: Departments of Internal Medicine, University Hospital Arnau de Vilanova, Lleida, Spain. jporcelp@medynet.com
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Porcel
authors.forename: Manuel
authors.initials: M
authors.lastname: Vives
authors.forename: Aureli
authors.initials: A
authors.lastname: Esquerda
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D015505:Chest Tubes; D004322:Drainage; D016724:Empyema, Pleural / Q000378:metabolism; D005260:Female; D005947:Glucose / Q000032:analysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D010996:Pleural Effusion / Q000737:chemistry* / Q000209:etiology; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000628:therapy; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha; D007770:L-Lactate Dehydrogenase; D005947:Glucose