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Combination of pleural TNF-a and LDH in an “or” rule, wherein the pleural space would be drained if any one of the two results are “positive,” yielded measures for sensitivity (91%; 95% CI, 78 to 100%), specificity (77%; 95% CI, 62 to 92%), and accuracy (83%; 95% CI, 72 to 93).
A significant but weak correlation was found between levels of TNF-a and percentage of neutrophils in pleural fluid (r = 0.26, p = 0.02) when considering the whole population of PPE. However, subgroup analysis showed no correlation between neither percentages nor absolute neutrophil counts and pleural TNF-a.
The present study suggests that pleural TNF-a may be a good biochemical marker of inflammation in patients with PPE. Elevated levels of pleural TNF-a identified more reliably the subgroup of patients with nonpurulent-appearing PPE who required invasive management with tube thoracostomy than traditional fluid chemistries.
Determining the need to drain a PPE can be a complex decision based not only on the microbiological and chemical fluid characteristics, but also on host factors and radiographic data. This decision should generally favor drainage, because the severe morbidity associated with progression to an empyema justifies the placement of a few extra chest tubes. Undoubtedly, results of thoracentesis provide essential information for patient management.
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