Cytological-energy analysis of pleural effusions

Abstract

Background Simultaneous cytological and metabolic investigation of the pleural effusion provides clinically relevant information about the type and intensity of immune response in the pleural cavity. Methods We investigated 1329 pleural effusions from patients with different pathological changes in the pleural cavity. Evaluated parameters were differential cell count of neutrophils, eosinophils, lymphocytes and monocytes, and values of the coefficient of energy balance. Results We found the lowest numbers of cells and the highest coefficient of energy balance values in patients with heart failure and sepsis; relatively high frequency of eosinophils and slightly decreased coefficient of energy balance values in patients with pneumothorax and haemothorax; the predominance of lymphocytes and low coefficient of energy balance values in patients with tuberculous pleuritis; the predominance of neutrophils and variable coefficient of energy balance values in patients after chest surgery; the highest presence of neutrophils and very low coefficient of energy balance values in patients with chest empyema and the predominance of lymphocytes and normal to low coefficient of energy balance values in patients with pleural malignancy. Conclusions Our findings in patients with heart failure and sepsis suggest the absence of inflammation in the pleural cavity. We observed the manifestation of tissue repair in patients with pneumothorax and haemothorax. Patients with tuberculous pleuritis were predominantly characterized by T cell-driven immune response and oxidative burst of macrophages. We found different intensities of immune responses to the chest surgery. The typical finding in patients with empyema was oxidative burst of neutrophils. In patients with pleural malignancy, weak cytotoxic inflammation predominates together with the intensive inflammation characterized by oxidative burst of macrophages.

Cytological-energy analysis of pleural effusions with predominance of neutrophils

“…Contrarily, we found very intense inflammation with oxidative burst of neutrophils as the sign of purulent inflammation in other patients. 8,22,[35][36][37][38] Glucose, glucose concentrations in the pleural effusions; KEB, coefficient of energy balance; LDH, lactate dehydrogenase catalytic activities in the pleural effusions; ROC, receiver operator characteristic Energy assessment of pleural effusions, contrary to their similar cellular composition, allows to distinguish between different immunity patterns in the pleural cavity. One aim of this study was to delineate between non-purulent immunity response and damaging purulent inflammation in the pleural cavity using the KEB values.…”

“…Contrarily, we found very intense inflammation with oxidative burst of neutrophils as the sign of purulent inflammation in other patients. 8,22,35–38…”

“…Our long-term experiences and recent studies have revealed as an optimal cut-off a KEB value of 10.0, to distinguish between 'purulent' and 'non-purulent' extravascular body fluids. [22][23][24][25] The intensity of local immunity response in the pleural effusions of patients without purulent complications, represented by KEB values, is similar to those in patients with transudative pleural effusions. Concentrations of LDH and AST catalytic activities in pleural effusions of these patients compared with patients with purulent complications are significantly lower (Table 1).…”

“…The KEB values represent the intensity of local inflammatory response. [22][23][24][25] Two energy models of the pleural compartment 22,23 Oxygen is dissolved in the pleural effusion under the physiological conditions, enabling predominantly aerobic metabolism in the pleural compartment. This is associated with a relatively high production of adenosine triphosphate (ATP), which is expressed as a high KEB value ( Figure 1).…”

“…Our aim was to identify dangerous purulent complication using the cytological-energy analysis of pleural effusions as early as possible, in groups of our patients with different impairments of pleural cavity. 22,23…”