Abstract
Background Thoracic ultrasound is an essential tool in the daily clinical care of pleural effusions and especially parapneumonic pleural effusions (PPEs), in terms of diagnosis, management, and follow-up. Hypoechogenicity index (HI) is a quantitative marker of pleural fluid echogenicity. We aimed to examine associations of HI with pleural inflammation in patients with PPE. Methods All patients included underwent a thoracic ultrasound with HI determination at the first day of their admission for a PPE. Thoracentesis was performed in all patients. Demographics, laboratory measurements, and clinical data were collected prospectively and recorded in all subjects. Results Twenty-four patients with PPE were included in the study. HI was statistically significantly correlated with intensity of inflammation as suggested by pleural fluid LDH (p < 0.001, r = −0.831), pleural fluid glucose (p=0.022, r = 0.474), and pleural fluid pH (p < 0.001, r = 0.811). HI was correlated with ADA levels (p=0.005, r = −0.552). We observed a statistically significant correlation of HI with pleural fluid total cell number (p < 0.001, r = −0.657) and polymorphonuclears percentage (p=0.02, r = −0.590), as well as days to afebrile (p=0.046, r = −0.411), duration of chest tube placement (p < 0.001, r = −0.806), and days of hospitalization (p=0.013, r = −0.501). Discussion. HI presents a fast, easily applicable, objective, and quantitative marker of pleural inflammation that reliably reflects the intensity of pleural inflammation and could potentially guide therapeutic management of PPE.
Highlights
Parapneumonic pleural effusion (PPE) refers to a pleural effusion which is associated with an infection of the pleural space. e majority of PPEs resolve with standard management such as antibiotics and pleural fluid drainage
All PPEs had predominantly polymononuclear cells. irteen patients were diagnosed with complicated PPE, while in the remaining 11 patients the pleural infection was resolved with antibiotic treatment and thoracocentesis alone
Our results demonstrated that hypoechogenicity Index (HI) is significantly correlated with the most essential biochemical biomarkers that reflect the intensity of pleural inflammation during the course of parapneumonic effusions such as pH, glucose, and LDH
Summary
Parapneumonic pleural effusion (PPE) refers to a pleural effusion which is associated with an infection of the pleural space. e majority of PPEs resolve with standard management such as antibiotics and pleural fluid drainage. E majority of PPEs resolve with standard management such as antibiotics and pleural fluid drainage. Despite the evolution of therapeutic strategies, 20% of patients with pleural infection will require surgical intervention, prolonging the hospital stay, raising the annual costs, and deteriorating the clinical outcomes [1]. Clinical trials have previously been conducted with the aim to improve drainage outcome in patients with complicated PPE with promising results; data on early, simple, and fast markers of progression of uncomplicated to complicated PPE are currently lacking [2, 3]. Thoracic ultrasound (TUS) has been included as an essential tool in the daily clinical practice in terms of diagnosis, management, and follow-up of pleural disease, including PPE [4, 5].
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