Diagnostic role of interleukin -33 in the differentiation of pleural effusions especially tuberculous and malignant effusions

Abstract

Background Tuberculous pleurisy and malignancy are two of the most common causes of pleural effusion. IL-33 is expressed in the epithelial lining and endothelial cells and is released after cell damage; it is proposed to have an essential role in sensing damage in various infectious and inflammatory diseases. This work aimed to determine the diagnostic role of IL-33 in pleural effusions. Methods One hundred seventeen patients with pleural effusions of different etiologies had a quantitative measurement of IL-33 in their pleural effusion and serum samples by ELISA technique. Results The concentrations of IL-33 (mean ± SD) in tuberculous pleural effusion (TPE) group (22.5 ± 0.90 ng/l) were significantly higher than that of malignant pleural effusion (MPE) group (14.6 ± 2.35 ng/l; P < 0.001). There is no significant difference between the serum levels of IL-33 in (TPE) group and (MPE) group ( P > 0.05). The concentrations of IL-33 in the pleural effusions were significantly correlated to that of the serum concentrations in each group (TPE: r = 0.848, P = < 0.001; MPE: r = 0.881, < 0.001) and pleural ADA in patients with tuberculous pleural effusions, ( r = 0.38, P < 0.001). The cut-off value of pleural IL33 for (TPE) was 19.16 ng/l, with a sensitivity of 91.7%, a specificity of 96.4%. The cutoff point of a pleural/ serum IL-33 ratio for the diagnosis of TPE was > 1.4 with a sensitivity of 91.7% and specificity of 100% while for the determination of (MPE) was < 0.9 with a sensitivity of 83.3% and specificity of 96.4%. Conclusion IL-33 level may serve as a novel biomarker to differentiate pleural effusions, especially tuberculous from malignant effusions.

Clinical diagnostic algorithm in defining tuberculous unilateral pleural effusion in high tuberculosis burden areas short of diagnostic tools

“…However, high levels of ADA can also be observed in pleural fluid from patients with parapneumonic effusions, empyema, malignancy, or rheumatoid disease (28), and the best ADA cut-off point for TPE remains controversial (29). In recent years, several new markers have been developed, such as TNF-α (30), interleukin-33 (8), and cell-free DNA (31). However, these markers are far from being widely used in clinics.…”

“…In China and many developing countries, pleural tuberculosis (TB) has been estimated to account for 6.5-8.7% of all TB cases (6), and considering the high prevalence of TB, tuberculous PE (TPE) is a major cause of all PE cases (7). However, the differentiation of TPE from other exudative PEs, especially malignant PE (MPE), remains a clinical challenge due to the similar clinical and laboratory manifestations presented and occasional lack of pathological or etiological evidence (8). Also, the paucibacillary TB and the slow growth of mycobacteria in the conventional culture media delays the precise diagnosis of TPE (9).…”

Diagnostic accuracy of interleukin-33 for tuberculous pleural effusion

“…Following an independent review, we eventually pooled 6 publications for analysis, [21][22][23][24][25][26] including 276 patients with TPE and 363 patients with non-TPE. The characteristics and quality scores of these studies are outlined in Table 1.…”