Ann Lab Med.  2013 Jan;33(1):45-51. 10.3343/alm.2013.33.1.45.

Association between Elevated Pleural Interleukin-33 Levels and Tuberculous Pleurisy

• Lee KS
• Kim HR
• Kwak S
• Choi KH
• Cho JH
• Lee YJ
• Lee MK
• Lee JH
• Park SD
• Park DS

• KMID: 1781297
• DOI: http://doi.org/10.3343/alm.2013.33.1.45

Abstract

BACKGROUND
Interferon-gamma (IFN-gamma) plays a crucial role in Mycobacterium tuberculosis induced pleural responses. Interleukin (IL)-33 up-regulates the production of IFN-gamma. We aimed to identify whether an association between pleural IL-33 levels and tuberculous pleurisy exists and determine its diagnostic value.
METHODS
Pleural IL-33, ST2 (a receptor of IL-33), adenosine deaminase (ADA), and IFN-gamma, as well as serum IL-33 and ST2 were measured in 220 patients with pleural effusions (PEs). Patients with malignant (MPEs), parapneumonic (PPEs), tuberculous (TPEs), and cardiogenic (CPEs) pleural effusions were included.
RESULTS
Pleural and serum IL-33 levels were highest or tended to be higher in patients with TPEs than in those with other types of PEs. The median pleural fluid-to-serum IL-33 ratio was higher in TPE cases (> or = 0.91) than in other PE cases (< or = 0.56). Pleural IL-33 levels correlated with those of pleural ADA and IFN-gamma. However, the diagnostic accuracies of pleural IL-33 (0.74) and pleural fluid-to-serum IL-33 ratio (0.75) were lower than that of ADA (0.95) or IFN-gamma (0.97). Pleural ST2 levels in patients with MPEs were higher than in patients with TPEs. Serum ST2 levels did not differ among the groups.
CONCLUSIONS
We identified an association between elevated pleural IL-33 levels and tuberculous pleurisy. However, we recommend conventional pleural markers (ADA or IFN-gamma) as diagnostic markers of TPE.

Keyword

Interleukin-33; ST2; Tuberculosis; Pleural effusion

MeSH Terms

Adenosine Deaminase/analysis
Adult
Aged
Aged, 80 and over
Area Under Curve
Case-Control Studies
Cross-Sectional Studies
Female
Humans
Interferon-gamma/analysis
Interleukins/*analysis/blood
Male
Middle Aged
Pleural Cavity/*metabolism
Pleural Effusion/diagnosis/metabolism
Pleural Effusion, Malignant/diagnosis/metabolism
ROC Curve
Receptors, Cell Surface/analysis/blood
Tuberculosis, Pleural/*diagnosis/metabolism
Interleukins
Receptors, Cell Surface
Interferon-gamma
Adenosine Deaminase

Figure

• 

  Fig. 1 Correlations between pleural IL-33 and pleural ADA or IFN-γ levels. *P<0.001 by Spearman's rank correlation analysis.Abbreviations: ADA, adenosine deaminase; IFN-γ, interferon gamma.

• 

  Fig. 2 Comparison of diagnostic accuracies of pleural IL-33, pleural fluid-to-serum (P/S) IL-33 ratio, and other markers in pleural effusions for discriminating between TPEs and non-TPEs using ROC curves. Small closed circles indicate cut-offs that were determined by the highest Youden index. A small open circle on the ADA curve (blue dotted line) indicates the cut-off value (30 IU/mL) that presented in studies [30] that used the same manufacturer's reagent.*P<0.05, IL-33 vs. ADA; †P<0.05, IL-33 vs. IFN-γ.Abbreviations: TPE, tuberculous pleural effusion; AUC, area under the ROC curve; Sens, sensitivity; Spec, specificity; ADA, adenosine deaminase; IFN-γ, interferon gamma.

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