Matrix Metalloproteinase Levels in the Differentiation of Parapneumonic Pleural Effusions

Abstract

Background: Matrix metalloproteinases (MMPs) have been implicated in the escalation of fibrosis and remodeling which are central to the subsequent progression of a parapneumonic pleural effusion to empyema. Objectives: The aim of this study was the assessment of MMP-2, MMP-8 and MMP-9 in parapneumonic pleural effusions in order to examine their value in the differentiation between uncomplicated and complicated parapneumonic effusions. Methods: The study included 208 consecutive patients with pleural effusions [60 parapneumonic (27 uncomplicated parapneumonic, 17 complicated parapneumonic, 16 empyemas), 24 tuberculous, 89 malignant and 35 transudates]. Concentrations of pleural fluid and serum MMP-2, MMP-8 and MMP-9 were determined by immunoassay. Results: Pleural fluid MMP-8 and MMP-9 levels were higher in complicated parapneumonic effusions or empyema than in uncomplicated effusions, while their serum levels were higher in complicated parapneumonic effusions. MMP-2 levels were higher in uncomplicated than in complicated parapneumonic effusions or empyema. Pleural fluid MMP-2/MMP-9 ratio was the best marker to differentiate complicated from uncomplicated parapneumonic effusions, with a sensitivity of 94.1% and a specificity of 77.8% at a cut-off point of 1.32 (AUC = 0.887). Conclusions: Pleural fluid MMP-2, MMP-8 and MMP-9 may provide useful information for differentiating between uncomplicated and complicated parapneumonic effusions.

Pleural fluid tests to identify complicated parapneumonic effusions

“…Currently, there are over 20 known mammalian MMPs, which share significant structural homologies. In a study [20] of 44 nonpurulent PPEs, evaluation of the pleural fluid concentrations of MMP-2, MMP-8 and MMP-9 was a powerful method to separate CPPE from UPPE (AUCs of 0.85, 0.81 and 0.85, respectively). Notably, an MMP-2-MMP-9 ratio lower than 1.32 represented the strongest predictor against a CPPE (likelihood ratio negative ¼ 0.08, CI 0.01-0.54).…”

Diagnostic accuracy of biomarkers of oxidative stress in parapneumonic pleural effusions

“…During this time, 214 consecutive patients who had undergone diagnostic thoracentesis for pleural effusion were studied. Seventy-eight of those patients have been included in another study of our department [13]. The reporting of the study conforms to STARD guidelines [14,15].…”

Perception versus Reality: The Measuring of Pleural Fluid pH in the United States

“…Given the emphasis of pleural fluid pH in the management of complicated parapneumonic and malignant effusions, physicians and hospital laboratories should consider either ensuring that the test runs properly or else consider using another tool to aid in their decision-making process. Perhaps other biochemical markers such as vascular endothelial growth factor or matrix metalloproteinase will be the preferred pleural fluid chemistry tests in the future to determine complicated parapneumonic effusion and its related pleural complications [31,32]. …”