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Measurements of pleural fluid biomarkers for rapid identification of complicated parapneumonic effusion (CPPE) are crucial for optimal management. Previous studies for biomarker evaluation were however based on pleura culture, not modern DNA technique. Lactate has not been thoroughly studied earlier as a potential biomarker in this regard. To evaluate whether the routine biomarkers pH, glucose, lactate dehydrogenase (LDH) measured in pleural fluid in a microbiological well characterised cohort could differentiate simple parapneumonic effusion (SPPE) from CPPE and if pleural fluid lactate could be of additional use in this discrimination. Pleural fluid prospectively collected from adult patients (n = 112) with PPE admitted to the Departments of Infectious Diseases (DIDs) at four Stockholm County hospitals were characterised microbiologically with bacterial culture and 16S rDNA sequencing, and biochemically with pH, glucose, LDH and lactate. Forty and seventy two patients were categorised as SPPE/CPPE. The median values between SPPE/CPPE differed significantly for all biomarkers with varying overlap. Receiver operating characteristics (ROC) curves showed the area under the curve (AUC) for pH 0.905 (CI 0.847–0.963), glucose 0.861 (CI 0.79–0.932), LDH 0.917 (CI 0.860–0.974) and lactate 0.927 (CI 0.877–0.977), corresponding to best cut-off levels and sensitivity/specificity for pH of 7.255, 0.819/0.9, glucose 5.35 mmol/L, 0.847/0.775, LDH 9.8 µcat/L, 0.905/0.825 and lactate 4.9 mmol/L, 0.875/0.85. To distinguish between SPPE/CPPE, pH and LDH performed well, but optimal cut-off values differed from earlier established recommendations. Pleura lactate had the largest AUC of the investigated biomarkers and may be used in the analyses of PPE-staging. [ABSTRACT FROM AUTHOR]

Parapneumonic pleural effusion (PPE) is a common complication in patients with pneumonia. Timely and accurate diagnosis of PPE is of great value for its management. Measurement of biomarkers in circulating and pleural fluid have the advantages of easy accessibility, short turn-around time, objectiveness and low cost and thus have utility for PPE diagnosis and stratification. To date, many biomarkers have been reported to be of value for the management of PPE. Here, we review the values of pleural fluid and circulating biomarkers for the diagnosis and stratification PPE. The biomarkers discussed are C-reactive protein, procalcitonin, presepsin, soluble triggering receptor expressed on myeloid cells 1, lipopolysaccharide-binding protein, inflammatory markers, serum amyloid A, soluble urokinase plasminogen activator receptor, matrix metalloproteinases, pentraxin-3 and cell-free DNA. We found that none of the available biomarkers has adequate performance for diagnosing and stratifying PPE. Therefore, further work is needed to identify and validate novel biomarkers, and their combinations, for the management of PPE. [ABSTRACT FROM AUTHOR]

Objectives: Accumulating evidence show that histone demethylases play important roles in various types of cancers, including non-small cell lung cancer (NSCLC). In the current study, we evaluated the diagnostic value of lysine(K)-specific demethylase 6B (KDM6B) in NSCLC. Methods: Serum KDM6B expression levels of 115 NSCLC patients and 88 healthy volunteers were detected by reverse transcription quantitative real-time polymerase chain reaction (qRT-PCR). The relationship between KDM6B and clinical characteristics was assessed by chi-square test. Receiver operating characteristic (ROC) analysis was applied to evaluate diagnostic efficacy. Results: Serum KDM6B was significantly lower in NSCLC patients than that in healthy controls (p <.001). Moreover, low KDM6B expression was significantly associated with the high clinical stage (p =.028) and positive lymph node metastasis (p =.031). Besides, we found that the expression of KDM6B mRNA was also significantly different among healthy controls, NSCLC early stage and later stage patients (p <.05). ROC curve indicated that KDM6B could serve as a diagnostic marker for NSCLC with the cut-off value of 0.955. The AUC was 0.897 with a sensitivity of 79.5% and specificity of 84.3%. Conclusion: Down-regulation of KDM6B is significantly associated with aggressive progression of NSCLC and KDM6B may be a tool of early detection of NSCLC. [ABSTRACT FROM AUTHOR]