IL-33 levels differentiate tuberculous pleurisy from malignant pleural effusions

Abstract

Tuberculous pleural effusions (TPEs) and malignant pleural effusions (MPEs) are difficult to differentiate between in certain clinical situations. Interleukin (IL)-33 is a cytokine that participates in inflammatory responses and may have a role in pleural effusions. The present study aimed to investigate the concentrations and potential differential significance of IL-33 in patients with TPE and MPE. IL-33 levels in pleural effusion and serum samples were detected using sandwich enzyme-linked immunosorbent assay in 23 patients with TPE and 21 patients with MPE. The concentration of IL-33 (mean ± standard deviation) in the TPE patients (22.962±0.976 ng/l) was significantly higher than that in the MPE patients (12.603±5.153 ng/l; P<0.001; z=−4.572); however, there was no significant difference in the serum level of IL-33 in the patients with TPE compared with those with MPE (P>0.05). The concentration of IL-33 in the pleural effusions was positively correlated with that in the serum samples in each group (TPE: r=0.563, P=0.05; MPE: r=0.535, P<0.05). The cut-off value of pleural IL-33 for TPE was 19.86 ng/l, which yielded a sensitivity of 0.869, a specificity of 0.905 and an area under the corresponding receiver operating characteristic curve of 0.903. The present study identified that the level of pleural IL-33 is significantly increased in TPEs and may serve as a novel biomarker to differentiate between patients with TPE and MPE.

Novel biomarker analysis of pleural effusion enhances differentiation of tuberculous from malignant pleural effusion

“…Consequently, the development of noninvasive methods is important to differentially diagnose these two diseases, including clinical decision trees 12 and nonroutine pleural fluid analysis (eg, ADA). 13 Accordingly, various PE biomarkers released during the immune response triggered by the presence of mycobacterial antigens or tumors in the pleural space have been investigated, such as ADA and interferon-g (IFN-g), particularly as well-recognized biomarkers for TPE, 14 , 15 but the diagnostic methods and performance seem to be variable. Thus, the objective of our study was to investigate PE biomarkers according to TB and cancer immunology to help distinguish these two common lymphocyte-predominant exudative PEs.…”

Diagnostic Value of Combined Pleural IL-33, ADA and Peripheral T-SPOT.TB for Tuberculous Pleurisy

“…The level of pleural uid IL-33 was positively correlated with pleural effusion ADA and peripheral blood T-SPOT.TB. Lee KS and Xuan WX and other scholars [9,10] found that the level of IL-33 in pleural effusion of patients with tuberculous pleurisy was signi cantly higher than other causes of pleural effusion and serum IL-33 levels, the sensitivity was 78% and 86.96%, speci city was 65% and 90.48% respectively. It was also suggested by Lee KS and other scholars that pleural uid IL-33 level and pleural ADA are signi cantly positively correlated [9].…”

“…The number of T cells secreting interferon-γ (IFN-γ) can be used as an auxiliary method for early diagnosis of tuberculosis [6,7]. Researches [8][9][10] showed that the level of interleukin-33 (IL-33) in pleural uid was signi cantly higher in patients with tuberculous pleurisy than in other causes. Therefore, we speculate that IL-33 may play an important role in the production of tuberculous pleural effusion (TPE).…”

New Biomarkers Used in the Diagnosis of Tuberculosis-Related Pleural Effusions

“…The following have also been studied as potential biomarkers in TPE diagnosis: neopterin, fibronectin, leptin, lysozyme, cytokines, and chemokines (IL-1β, IL-2, sIL-2, IL-6, IL-8, IL-12p40, IL-16, IL-33, tumor necrosis factor-α, and CXCL12), complementary activation, serum antibodies, IP-10, dipeptidyl peptidase, indolamine 2,3 dioxygenase, superoxide dismutase, nitric oxide, YKL-40, matrix metalloproteinase-9, angiotensin-converting enzyme (ACE)/ACE2 rate. 15,16,28,29,[42][43][44][45][46][47][48][49][50][51][52][53] However, none of these biomarkers having been studied so far had superiority to ADA in terms of cost, administration convenience, standardization, defined diagnosis threshold value, and more importantly, diagnosis accuracy.…”