title: The value of total protein in guiding management of infectious parapneumonic effusion by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.
abstract: OBJECTIVE
  Infectious parapneumonic effusion (PE) contains proteins originating from circulation as well as proteins locally released by inflammatory pulmonary cells. The purpose of this study was to investigate the value of total protein analysis in guiding management of infectious PE by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.
  
  
  METHODS
  Fifty-seven children with pneumonia followed by PE were consecutively enrolled into our study. Protein profiles generated by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry after fractionating samples with functionalized magnetic beads (C8) were used for differentiating complicated PE (CPE) from non-CPE. A training set was used to generate classification models and the clinical efficacy of these models in detecting CPE and the need for intervention was then evaluated in an independent set.
  
  
  RESULTS
  The MS spectra derived from PE were analyzed, and classification models were constructed in the training set. A total of 123 mass/charge (m/z) values were identified and 23 m/z values which were significant with p < 0.05 were used as classifiers. An optimized genetic algorithm model containing enforced selection of three significant downregulated m/z values (2127, 2232, and 2427) was able to classify CPE with 100% positive predictive value and predict the need of aggressive therapeutic intervention with 77% positive predictive value.
  
  
  CONCLUSIONS
  A diagnostic model construction comprising three potential biomarkers can predict CPE and need for surgical intervention rapidly and precisely. Pleural fluid proteins downregulated during the progression of pneumonia could potentially guide the management of infectious PE.
authors.affiliation: Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Pulmonology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chih-Yung
authors.initials: CY
authors.lastname: Chiu
authors.affiliation: Department of Clinical Proteomics Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Sen-Yung
authors.initials: SY
authors.lastname: Hsieh
authors.affiliation: Division of Pediatric Pulmonology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Kin-Sun
authors.initials: KS
authors.lastname: Wong
authors.affiliation: Division of Pediatric Pulmonology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shen-Hao
authors.initials: SH
authors.lastname: Lai
authors.affiliation: Center for Nanomedicine Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
authors.forename: Jen-Kun
authors.initials: JK
authors.lastname: Chen
authors.affiliation: Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: long@adm.cgmh.org.tw.
authors.forename: Jing-Long
authors.initials: JL
authors.lastname: Huang
mesh_terms: D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005122:Exudates and Transudates / Q000737:chemistry*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010996:Pleural Effusion / Q000175:diagnosis*; D011014:Pneumonia / Q000150:complications*; D011237:Predictive Value of Tests; D011506:Proteins / Q000032:analysis*; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization / Q000379:methods*
chemical_list: D011506:Proteins
keywords: Biomarkers; Complicated parapneumonic effusion; Surgical intervention