title: Clinical importance of angiogenic cytokines, fibrinolytic activity and effusion size in parapneumonic effusions.
abstract: OBJECTIVE
  To investigate the relationship among angiogenic cytokines, fibrinolytic activity and effusion size in parapneumonic effusion (PPE) and their clinical importance.
  
  
  METHODS
  From January 2008 through December 2010, 26 uncomplicated (UPPE) and 38 complicated (CPPE) PPE were studied. Based on chest ultrasonography, there were non-loculated in 30, uni-loculated in 12, and multi-loculated effusions in 22 patients. The effusion size radiological scores, and effusion vascular endothelial growth factor (VEGF), interleukin (IL)-8, plasminogen activator inhibitor type-1 (PAI-1) and tissue type plasminogen activator (tPA) were measured on admission. Treatment outcome and pleural fibrosis, defined as radiological residual pleural thickening (RPT), were assessed at 6-month follow-up.
  
  
  RESULTS
  The effusion size and effusion VEGF, IL-8 and PAI-1/tPA ratio were significantly higher in CPPE than in UPPE, and significantly higher in multi-loculated PPE than in non-locualted and uni-loculated PPE, respectively. VEGF (cutoff value 1975 pg/ml) and IL-8 (cutoff value 1937 pg/ml) seemed best to discriminate between UPPE and CPPE. VEGF, IL-8 and effusion size correlated positively with PAI-1/tPA ratio in both UPPE and CPPE. Moreover, the level of VEGF, but not IL-8, correlated positively with effusion size in all patients (r = 0.79, p<0.001) and in UPPE (r = 0.64, p<0.001) and CPPE (r = 0.71, p<0.001) groups. The patients with higher VEGF or greater effusion were prone to have medical treatment failure (n = 10; VEGF, odds ratio 1.01, p = 0.02; effusion size, odds ratio 1.26, p = 0.01). Additionally, ten patients with RPT had larger effusion size and higher levels of VEGF and PAI-1/tPA ratio than did those without.
  
  
  CONCLUSIONS
  In PPE, VEGF and IL-8 levels are valuable to identify CPPE, and higher VEGF level or larger effusion is associated with decreased fibrinolytic activity, development of pleural loculation and fibrosis, and higher risk of medical treatment failure.
authors: Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
authors: Chi-Li
authors: CL
authors: Chung
authors: Shih-Hsin
authors: SH
authors: Hsiao
authors: George
authors: G
authors: Hsiao
authors: Joen-Rong
authors: JR
authors: Sheu
authors: Wei-Lin
authors: WL
authors: Chen
authors: Shi-Chuan
authors: SC
authors: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016207:Cytokines; D005260:Female; D005342:Fibrinolysis; D005500:Follow-Up Studies; D006801:Humans; D016209:Interleukin-8 / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis*; D010994:Pleura / Q000187:drug effects / Q000473:pathology*; D010996:Pleural Effusion / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D011014:Pneumonia / Q000150:complications; D010959:Tissue Plasminogen Activator / Q000032:analysis*; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis*
chemical_list: D000900:Anti-Bacterial Agents; D016207:Cytokines; D016209:Interleukin-8; D017395:Plasminogen Activator Inhibitor 1; D042461:Vascular Endothelial Growth Factor A; D010959:Tissue Plasminogen Activator