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. 2019 Jun 18;19(1):108.
doi: 10.1186/s12890-019-0877-8.

Combined serum biomarkers in the noninvasive diagnosis of complicated parapneumonic effusions and empyema

Kuo-An Wu  1   2 , Chih-Ching Wu  3   4   5 , Yu-Ching Liu  3 , Pei-Chun Hsueh  6 , Chia-Yin Chin  5 , Chih-Liang Wang  7   8 , Chi-Ming Chu  9 , Li-Jane Shih  10 , Chia-Yu Yang  11   12   13   14
Affiliations

Combined serum biomarkers in the noninvasive diagnosis of complicated parapneumonic effusions and empyema

Kuo-An Wu et al. BMC Pulm Med. .

Abstract

Background: We previously demonstrated that the pleural levels of proteins (neutrophil gelatinase-associated lipocalin/NGAL, calprotectin, bactericidal permeability-increasing/BPI, azurocidin 1/AZU-1) were valuable markers for identifying complicated PPE (CPPE). Herein, this study was performed to evaluate whether these proteins are useful as serological markers for identifying CPPE and empyema.

Methods: A total of 137 participates were enrolled in this study. The levels of NGAL, calprotectin, BPI and AZU-1 were measured in serum and pleural fluid by enzyme-linked immunosorbent assay. We also characterized the diagnostic values of these markers between different groups.

Results: The serum levels of NGAL, calprotectin, and BPI in PPE patients were significantly higher than those in transudates, noninfectious exudates, and healthy controls. The area under the curve (AUC) values of NGAL, calprotectin, and BPI for distinguishing PPE from transudates or noninfectious exudates were around 0.861 to 0.953. In PPE group, serum NGAL and calprotectin levels were significantly elevated in patients with CPPE and empyema than in those with UPPE, whereas the serum BPI levels were similar between these two groups. In CPPE and empyema patients, the serum NGAL showed a positive correlation with the pleural fluid NGAL (r = 0.417, p < 0.01). When combined with serum CRP, the sensitivity and specificity of serum calprotectin for identifying CPPE and empyema were the highest at 73.52% and 80.55%, respectively.

Conclusions: We concluded that serum calprotectin and NGAL were adjuvant serological markers for CPPE and empyema diagnosis. Patients present with pneumonia and pleural effusion signs in the chest x-ray and the combination of serum calprotectin and CRP constitutes a more highly sensitive and specific assay for identifying CPPE and empyema.

Keywords: AZU1; BPI; Calprotectin; NGAL; PPE; Serum biomarker.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The diagnostic power of serum CRP, calprotectin, and NGAL for identifying CPPE and empyema. Diagnostic power of serum CRP combined with calprotectin (a) and serum CRP combined with NGAL (b) in CPPE and empyema
See this image and copyright information in PMC

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