Angiogenic Cytokines and Fibrinolytic Activity in Tuberculous Pleural Effusion

Abstract

SESSION TITLE: Disorders of the Pleura Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: To investigate the relationship among angiogenic cytokines, inflammatory markers and fibrinolytic activity in tuberculous pleural effusion (TBPE) and their clinical importance. METHODS: Forty-two patients diagnosed with TBPE were studied. Based on chest ultrasonography, there were 26 loculated and 16 non-loculated TBPE 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. 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 lactate dehydrogenase (LDH), VEGF, IL-8, PAI-1 and PAI-1/tPA ratio were significantly higher, while effusion glucose, pH value and tPA were significantly lower, in loculated than in non-loculated TBPE. VEGF and IL-8 correlated positively with LDH and PAI-1/tPA ratio, and negatively with tPA in both loculated and non-loculated TBPE. Patients with higher VEGF or greater effusion size were prone to develop RPT (n=14; VEGF, odds ratio 1.28, p=0.01; effusion size, odds ratio 1.01, p=0.02), and VEGF was an independent predictor of RPT in TBPE (receiver-operating characteristic curve AUC=0.985, p<0.001). Effusion VEGF at the cutoff level > 842 pg/ml had highest sensitivity and specificity for predicting RPT in TBPE patients (sensitivity 100%, 95% CI = 76.8-100%; specificity 89.3%, 95% CI = 71.8-97.7%). CONCLUSIONS: Effusion levels of VEGF and IL-8 correlate with increased pleural inflammation and decreased fibrinolytic activity in TBPE. Effusion VEGF may be of value to predict pleural fibrosis in TBPE. CLINICAL IMPLICATIONS: Further preclinical studies and clinical trials are required to investigate the potential use of targeting VEGF as a therapeutic strategy adjunct to standard anti-TB treatment for TBPE. DISCLOSURE: The following authors have nothing to disclose: Wen-Yueh Hung No Product/Research Disclosure Information