Diagnosis of Parapneumonia Pleural Effusion with Serum and Pleural Fluid Cell-Free DNA

Chih-Min Su,Yun-Ru Lai,Hung-Chen Wang,Nai-Wen Tsai,Cheng-Hsien Lu,Ben-Chung Cheng,Wei-Che Lin,Chia-Te Kung,Yu-Jih Su,Chih-Cheng Huang,Sheng-Yuan Hsiao

doi:10.1155/2019/5028512

Abstract

Objective As cell-free DNA levels in the pleural fluid and serum of parapneumonic pleural effusion (PPE) patients have not been thoroughly explored, we evaluated their diagnostic potential. Methods Twenty-two PPE and 16 non-PPE patients were evaluated. Serum and pleural fluids were collected, and cell-free DNA was quantified. All biomarkers were assessed for correlation with days after admission. Receiver operating characteristic (ROC) curve analysis was used to determine diagnostic accuracy and optimal cut-off point. Results Nuclear and mitochondrial DNA levels in the pleural fluid and nuclear DNA levels in serum of PPE patients were significantly higher than in those of the non-PPE patients. However, only cell-free DNA levels in pleural fluid correlated with days after admission among PPE patients (r= 0.464, 0.538, respectively). ROC curve analysis showed that nuclear and mitochondrial DNA in pleural fluid had AUCs of 0.945 and 0.889, respectively. With cut-off values of 134.9 and 17.8 ng/ml for nuclear and mitochondrial DNA in pleural fluid, respectively, 96% sensitivity and 81% specificity were observed for PPE diagnosis. Conclusion Nuclear and mitochondrial DNA in pleural fluid possess PPE diagnostic potential and correlated with disease severity. Serum nuclear DNA could also be used to distinguish freshly admitted PPE patients (Day 1) from non-PPE patients, but with less accuracy.

Highlights

It is critical to determine the cause of pleural effusion because means of treatment is decided based on etiology of the disease [1]
Patients aged ≥20 years who were consecutively admitted to the emergency department (ED) of Kaohsiung Chang Gung Memorial Hospital (CGMH) were screened for pleural effusion by chest X-ray, chest computerized tomography (CT), or chest sonography
Pleural fluid nuclear and mitochondrial DNA levels correlated with that of all other biomarkers in pleural fluid, and with their own DNA levels in serum, pleural fluid nuclear and mitochondrial DNA were the only two biomarkers that correlated with days after admission, a variable that could represent the severity of disease in parapneumonic pleural effusion (PPE) patients

Summary

Introduction

It is critical to determine the cause of pleural effusion because means of treatment is decided based on etiology of the disease [1]. Correct diagnosis of parapneumonic pleural effusion (PPE) is most important, because in addition to appropriate antibiotics, patients sometimes need adequate drainage or surgical intervention to cure the disease [2]. Some studies have reported that up to 40% of bacterial pneumonia includes PPE [3]. Small PPEs may be resolved solely by treatment with antibiotics, some patients will develop complicated PPE and/or empyema. Dean et al showed that patients admitted to emergency rooms with pneumonia and pleural effusion had higher mortality rates and longer hospital stays [4]

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Conclusion