Repeated thoracenteses affect proinflammatory cytokines, vascular endothelial growth factor, and fibrinolytic activity in pleural transudates

Chi Li Chung, Ching-Ying Yeh, Joen Rong Sheu, Yi Chu Chen, Shi Chuan Chang

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: Repeated thoracenteses is indicated in patients with refractory, symptomatic transudative effusions. However, their effect on cytokines and fibrinolytic activity in pleural transudates remains unclear. METHODS: Twenty-one patients with symptomatic, large amount of free-flowing transudative effusions caused by heart failure were studied. Thoracentesis with drainage of 500 mL of pleural fluid per day was done for 3 consecutive days (days 1 to 3). Pleural fluid characteristics, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-8, vascular endothelial growth factor (VEGF), tissue-type plasminogen activator (tPA), and plasminogen activator inhibitor type 1 (PAI-1) were measured during each tap. Chest ultrasonography was done on day 6 to detect the fibrin strands in pleural effusion and the outcome of effusion was evaluated within 7 days after repeated thoracenteses. RESULTS: Effusion levels of lactate dehydrogenase, neutrophils, TNF-α, IL-1β, IL-8, VEGF, and PAI-1 increased significantly during repeated thoracenteses. Furthermore, the values of PAI-1 and PAI-1/tPA obtained on days 2 and 3 were highly correlated with those of TNF-α, IL-1β, IL-8, and VEGF. On day 6, pleural fibrins were observed on chest ultrasonography in 6 patients (29%, fibrinous group) but were absent in the remaining 15 patients (nonfibrinous group). Compared with the nonfibrinous group, the effusion levels of TNF-α, IL-1β, VEGF, and PAI-1 on day 2 and day 3, and recurrence of symptomatic effusion after repeated thoracenteses were significantly higher in fibrinous group. CONCLUSIONS: Repeated thoracenteses may induce local release of proinflammatory cytokines, VEGF and PAI-1, which may result in fibrin deposition and impair resolution of pleural transudates.

Original languageEnglish
Pages (from-to)452-457
Number of pages6
JournalAmerican Journal of the Medical Sciences
Volume334
Issue number6
DOIs
Publication statusPublished - Dec 2007

Fingerprint

Plasminogen Activator Inhibitor 1
Exudates and Transudates
Vascular Endothelial Growth Factor A
Cytokines
Interleukin-1
Tumor Necrosis Factor-alpha
Fibrin
Interleukin-8
Ultrasonography
Thorax
Plasminogen Inactivators
Plasminogen Activators
Tissue Plasminogen Activator
Pleural Effusion
L-Lactate Dehydrogenase
Thoracentesis
Drainage
Neutrophils
Heart Failure
Recurrence

Keywords

  • Fibrinogenesis
  • Pleural effusion
  • Proinflammatory cytokine
  • Thoracentesis
  • Transudates

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Repeated thoracenteses affect proinflammatory cytokines, vascular endothelial growth factor, and fibrinolytic activity in pleural transudates. / Chung, Chi Li; Yeh, Ching-Ying; Sheu, Joen Rong; Chen, Yi Chu; Chang, Shi Chuan.

In: American Journal of the Medical Sciences, Vol. 334, No. 6, 12.2007, p. 452-457.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Repeated thoracenteses is indicated in patients with refractory, symptomatic transudative effusions. However, their effect on cytokines and fibrinolytic activity in pleural transudates remains unclear. METHODS: Twenty-one patients with symptomatic, large amount of free-flowing transudative effusions caused by heart failure were studied. Thoracentesis with drainage of 500 mL of pleural fluid per day was done for 3 consecutive days (days 1 to 3). Pleural fluid characteristics, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-8, vascular endothelial growth factor (VEGF), tissue-type plasminogen activator (tPA), and plasminogen activator inhibitor type 1 (PAI-1) were measured during each tap. Chest ultrasonography was done on day 6 to detect the fibrin strands in pleural effusion and the outcome of effusion was evaluated within 7 days after repeated thoracenteses. RESULTS: Effusion levels of lactate dehydrogenase, neutrophils, TNF-α, IL-1β, IL-8, VEGF, and PAI-1 increased significantly during repeated thoracenteses. Furthermore, the values of PAI-1 and PAI-1/tPA obtained on days 2 and 3 were highly correlated with those of TNF-α, IL-1β, IL-8, and VEGF. On day 6, pleural fibrins were observed on chest ultrasonography in 6 patients (29{\%}, fibrinous group) but were absent in the remaining 15 patients (nonfibrinous group). Compared with the nonfibrinous group, the effusion levels of TNF-α, IL-1β, VEGF, and PAI-1 on day 2 and day 3, and recurrence of symptomatic effusion after repeated thoracenteses were significantly higher in fibrinous group. CONCLUSIONS: Repeated thoracenteses may induce local release of proinflammatory cytokines, VEGF and PAI-1, which may result in fibrin deposition and impair resolution of pleural transudates.",
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T1 - Repeated thoracenteses affect proinflammatory cytokines, vascular endothelial growth factor, and fibrinolytic activity in pleural transudates

AU - Chung, Chi Li

AU - Yeh, Ching-Ying

AU - Sheu, Joen Rong

AU - Chen, Yi Chu

AU - Chang, Shi Chuan

PY - 2007/12

Y1 - 2007/12

N2 - BACKGROUND: Repeated thoracenteses is indicated in patients with refractory, symptomatic transudative effusions. However, their effect on cytokines and fibrinolytic activity in pleural transudates remains unclear. METHODS: Twenty-one patients with symptomatic, large amount of free-flowing transudative effusions caused by heart failure were studied. Thoracentesis with drainage of 500 mL of pleural fluid per day was done for 3 consecutive days (days 1 to 3). Pleural fluid characteristics, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-8, vascular endothelial growth factor (VEGF), tissue-type plasminogen activator (tPA), and plasminogen activator inhibitor type 1 (PAI-1) were measured during each tap. Chest ultrasonography was done on day 6 to detect the fibrin strands in pleural effusion and the outcome of effusion was evaluated within 7 days after repeated thoracenteses. RESULTS: Effusion levels of lactate dehydrogenase, neutrophils, TNF-α, IL-1β, IL-8, VEGF, and PAI-1 increased significantly during repeated thoracenteses. Furthermore, the values of PAI-1 and PAI-1/tPA obtained on days 2 and 3 were highly correlated with those of TNF-α, IL-1β, IL-8, and VEGF. On day 6, pleural fibrins were observed on chest ultrasonography in 6 patients (29%, fibrinous group) but were absent in the remaining 15 patients (nonfibrinous group). Compared with the nonfibrinous group, the effusion levels of TNF-α, IL-1β, VEGF, and PAI-1 on day 2 and day 3, and recurrence of symptomatic effusion after repeated thoracenteses were significantly higher in fibrinous group. CONCLUSIONS: Repeated thoracenteses may induce local release of proinflammatory cytokines, VEGF and PAI-1, which may result in fibrin deposition and impair resolution of pleural transudates.

AB - BACKGROUND: Repeated thoracenteses is indicated in patients with refractory, symptomatic transudative effusions. However, their effect on cytokines and fibrinolytic activity in pleural transudates remains unclear. METHODS: Twenty-one patients with symptomatic, large amount of free-flowing transudative effusions caused by heart failure were studied. Thoracentesis with drainage of 500 mL of pleural fluid per day was done for 3 consecutive days (days 1 to 3). Pleural fluid characteristics, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-8, vascular endothelial growth factor (VEGF), tissue-type plasminogen activator (tPA), and plasminogen activator inhibitor type 1 (PAI-1) were measured during each tap. Chest ultrasonography was done on day 6 to detect the fibrin strands in pleural effusion and the outcome of effusion was evaluated within 7 days after repeated thoracenteses. RESULTS: Effusion levels of lactate dehydrogenase, neutrophils, TNF-α, IL-1β, IL-8, VEGF, and PAI-1 increased significantly during repeated thoracenteses. Furthermore, the values of PAI-1 and PAI-1/tPA obtained on days 2 and 3 were highly correlated with those of TNF-α, IL-1β, IL-8, and VEGF. On day 6, pleural fibrins were observed on chest ultrasonography in 6 patients (29%, fibrinous group) but were absent in the remaining 15 patients (nonfibrinous group). Compared with the nonfibrinous group, the effusion levels of TNF-α, IL-1β, VEGF, and PAI-1 on day 2 and day 3, and recurrence of symptomatic effusion after repeated thoracenteses were significantly higher in fibrinous group. CONCLUSIONS: Repeated thoracenteses may induce local release of proinflammatory cytokines, VEGF and PAI-1, which may result in fibrin deposition and impair resolution of pleural transudates.

KW - Fibrinogenesis

KW - Pleural effusion

KW - Proinflammatory cytokine

KW - Thoracentesis

KW - Transudates

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