Rationale: Parapneumonic effusions have a wide clinical spectrum. The majority settle with conservative management but some progress to complex collections requiring intervention. For decades, physicians have relied on pleural fluid pH to determine the need for chest tube drainage despite a lack of prospective validation and no ability to predict the requirement for fibrinolytics or thoracic surgery.Objectives: To study the ability of suPAR (soluble urokinase plasminogen activator receptor), a potential biomarker of pleural fluid loculation, to predict the need for invasive management compared with conventional fluid biomarkers (pH, glucose, and lactate dehydrogenase) in parapneumonic effusions.Methods: Patients presenting with pleural effusions were prospectively recruited to an observational study with biological samples stored at presentation. Pleural fluid and serum suPAR levels were measured using the suPARnostic double-monoclonal antibody sandwich ELISA on 93 patients with parapneumonic effusions and 47 control subjects (benign and malignant effusions).Measurements and Main Results: Pleural suPAR levels were significantly higher in effusions that were loculated versus nonloculated parapneumonic effusions (median, 132 ng/ml vs. 22 ng/ml; P < 0.001). Pleural suPAR could more accurately predict the subsequent insertion of a chest tube with an area under the curve (AUC) of 0.93 (95% confidence interval, 0.89-0.98) compared with pleural pH (AUC 0.82; 95% confidence interval, 0.73-0.90). suPAR was superior to the combination of conventional pleural biomarkers (pH, glucose, and lactate dehydrogenase) when predicting the referral for intrapleural fibrinolysis or thoracic surgery (AUC 0.92 vs. 0.76).Conclusions: Raised pleural suPAR was predictive of patients receiving more invasive management of parapneumonic effusions and added value to conventional biomarkers. These results need validation in a prospective multicenter trial.

中文翻译：

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胸膜液suPAR水平可预测肺炎旁肺积液中侵入性治疗的需求。

理由：肺炎旁积液具有广泛的临床范围。多数人采用保守的管理方式解决，但在一些复杂的收集工作上需要一些干预。几十年来，尽管缺乏前瞻性验证并且无法预测纤溶剂或胸外科手术的需求，但医生仍依靠胸水pH来确定是否需要胸管引流。目的：研究suPAR（可溶性尿激酶纤溶酶原激活剂）的能力受体），一种潜在的胸膜积液生物标志物，与肺炎旁肺积液中常规的液体生物标志物（pH，葡萄糖和乳酸脱氢酶）相比，可以预测是否需要进行侵入性治疗。方法：前瞻性招募有胸膜积液的患者进行观察性研究。展示时存储了生物样本。使用suPARnostic双单克隆抗体夹心ELISA对93例肺炎旁积液和47例对照受试者（良性和恶性积液）的胸水和血清suPAR水平进行了测量。与非定位性肺炎旁积液相比（中位数132 ng / ml对22 ng / ml； P <0.001）。与胸膜pH值（AUC 0.82; 95％置信区间0.73-0.90）相比，胸膜suPAR可以更准确地预测随后的胸管插入曲线下面积（AUC）为0.93（95％置信区间为0.89-0.98）。 ）。当预测转诊进行胸膜内纤溶或胸外科手术时（AUC 0。），suPAR优于常规胸膜生物标志物（pH，葡萄糖和乳酸脱氢酶）的组合。92 vs. 0.76）。结论：胸膜suPAR升高预示着患者将接受更多的侵入性肺炎旁渗液治疗，并增加常规生物标记物的价值。这些结果需要在前瞻性多中心试验中进行验证。