Bedawi, Eihab O;
Kanellakis, Nikolaos I;
Corcoran, John P;
Zhao, Yu;
Hassan, Maged;
Asciak, Rachelle;
Mercer, Rachel M;
... Rahman, Najib M; + view all
(2023)
The Biological Role of Pleural Fluid PAI-1 and Sonographic Septations in Pleural Infection: Analysis of a Prospectively Collected Clinical Outcome Study.
American Journal of Respiratory and Critical Care Medicine
, 207
(6)
pp. 731-739.
10.1164/rccm.202206-1084OC.
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Abstract
RATIONALE: Sonographic septations are assumed to be important clinical predictors of outcome in pleural infection but the evidence for this is sparse. The inflammatory and fibrinolysis-associated intrapleural pathway(s) leading to septation formation have not been studied in a large cohort of pleural fluid (PF) samples with confirmed pleural infection, matched with ultrasound and clinical outcome data. OBJECTIVES: To assess the presence and severity of septations against baseline PF Plasminogen-Activator Inhibitor-1 (PAI-1) and other inflammatory and fibrinolysis-associated proteins as well as to correlate these with clinically important outcomes. METHODS: We analysed 214 pleural fluid samples from the PILOT study, a prospective observational pleural infection study, for inflammatory and fibrinolysis-associated proteins using the Luminex platform. Multivariate regression analyses were utilised to assess association of pleural biological markers with septation presence and severity (on ultrasound), and clinical outcomes. RESULTS: PF PAI-1 level was the only protein independently associated with septation presence (p=<0.001) and septation severity (p=0.003). PF PAI-1 levels were associated with increased length of stay (LOS) (p=0.048) and increased 12-month mortality (p=0.003). Sonographic septations alone had no relation to clinical outcomes. CONCLUSIONS: In a large and well characterised cohort, this is the first study to associate pleural biological parameters with a validated sonographic septation outcome in pleural infection. PF PAI-1 is the first biomarker to demonstrate an independent association with mortality. While PF PAI-1 plays an integral role in driving septation formation, septations themselves are not associated with clinically important outcomes. These novel findings now require prospective validation.
| Type: | Article |
|---|---|
| Title: | The Biological Role of Pleural Fluid PAI-1 and Sonographic Septations in Pleural Infection: Analysis of a Prospectively Collected Clinical Outcome Study |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1164/rccm.202206-1084OC |
| Publisher version: | https://doi.org/10.1164/rccm.202206-1084OC |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | empyema, fibrinolysis, pleural infection, septations |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10156829 |
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