ABSTRACT
BACKGROUND: Pleural effusions develop for various reasons in patients admitted to intensive care units (ICUs). To understand why this occurs is important, yet cytokine levels in pleural effusions have rarely been measured from a cardiovascular viewpoint. OBJECTIVE: To understand the characteristics of pleural cytokines in patients admitted to the ICU. METHODS: The subjects were 43 patients with pleural effusion who were admitted to the ICU from June 2001 through March 2006. We divided the patients into transudate (n=23) and exudate (n=20) groups. We measured levels of interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-alpha in pleural effusions and peripheral blood and evaluated their relationships with body temperature, C-reactive protein (CRP) level, and the peripheral white blood cell (WBC) count. RESULTS: Levels of pleural IL-6 were significantly higher and levels of TNF-alpha tended to be higher in pleural effusions from the exudate than in those from the transudate group (3,350+/-3,627 vs. 1,677+/-1,086 pg/m and 6.6+/-3.4 vs. 4.8+/-2.6 pg/mL, respectively). However, in both groups levels of IL-10 in pleural effusions were similar to those in serum and levels of IL-6 were significantly higher in pleural effusion than in serum. Serum IL-6 levels correlated with inflammatory markers (CRP and body temperature), whereas cytokines in pleural effusion did not correlate with any of these markers (body temperature, CRP, and WBC). CONCLUSION: Pleural levels of IL-6 were significantly higher in the exudate group than in the transudate group but did not correlate with serum levels of IL-6 or with systemic inflammatory markers. These findings suggest that pleural IL-6 levels correlate with local lung or pleural inflammation in patients admitted to the ICU.
Subject(s)
Critical Care , Interleukin-6/analysis , Pleural Effusion/chemistry , Pleural Effusion/etiology , Aged , Aged, 80 and over , Biomarkers/analysis , Exudates and Transudates/chemistry , Female , Humans , Inflammation Mediators/analysis , Interleukin-10/analysis , Male , Pleural Effusion/diagnosis , Tumor Necrosis Factor-alpha/analysisABSTRACT
BACKGROUND: Acute aortic dissection (AAD) is a life-threatening cardiovascular disorder that is similar to acute coronary syndrome (ACS), which means differentiating AAD and ACS is sometimes difficult in an emergency. METHODS AND RESULTS: Specific information from 131 patients with AAD or ACS was analyzed between April 2001 and March 2002. The emergency room AAD (ERAAD) score was defined as the total number of specific indexes for AAD among 15 indexes that were obtainable in the emergency room (Study 1). The clinical applicability of the ERAAD score was also investigated in another 711 patients with AAD or ACS between April 2002 and March 2006 (Study 2). The ERAAD score was based on (1) presence of back pain, (2) mediastinal thoracic ratio >30%, (3) aortic regurgitation and (4) aortic diameter >30 mm on ultrasonography in Study 1. The ERAAD score was significantly higher in patients with AAD than with ACS (3.19+/-0.83 vs 1.17+/-0.99) in Study 2. The sensitivity and specificity for AAD were 93.1% and 77.6%, respectively, when the ERAAD score was >or=3. CONCLUSION: The ERAAD score enables clinical diagnosis of AAD and correct treatment.
