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Pleural Fluid suPAR Levels Predict the Need for Invasive Management in Parapneumonic Effusions.

David T Arnold¹, Fergus W Hamilton², Karen T Elvers¹

¹Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom.

American Journal of Respiratory and Critical Care Medicine

|February 19, 2020

Summary

Soluble urokinase plasminogen activator receptor (suPAR) in pleural fluid can predict the need for invasive management of parapneumonic effusions. suPAR shows greater accuracy than traditional biomarkers like pH for guiding treatment decisions.

Keywords:

empyema pleural effusion pneumonia suPAR

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Area of Science:

Pulmonology
Biomarker Discovery
Thoracic Medicine

Background:

Parapneumonic effusions range from simple to complex, requiring intervention.
Current methods for determining intervention, like pleural fluid pH, lack prospective validation.
Predicting the need for fibrinolytics or surgery remains challenging with existing biomarkers.

Purpose of the Study:

To evaluate soluble urokinase plasminogen activator receptor (suPAR) as a biomarker for pleural fluid loculation.
To compare suPAR's ability to predict invasive management against conventional biomarkers (pH, glucose, LDH).
To assess suPAR's utility in predicting the need for chest tube insertion, fibrinolysis, or surgery.

Main Methods:

Prospective observational study of patients with pleural effusions.
Measurement of pleural fluid and serum suPAR levels using ELISA.
Comparison of suPAR with pleural fluid pH, glucose, and lactate dehydrogenase (LDH).

Main Results:

Pleural suPAR levels were significantly higher in loculated parapneumonic effusions.
suPAR demonstrated superior accuracy (AUC 0.93) in predicting chest tube insertion compared to pH (AUC 0.82).
suPAR outperformed conventional biomarkers (AUC 0.92 vs. 0.76) in predicting the need for fibrinolysis or surgery.

Conclusions:

Elevated pleural suPAR levels predict the need for more invasive management of parapneumonic effusions.
suPAR provides added value to conventional biomarkers in guiding treatment decisions.
Further validation in a prospective multicenter trial is warranted.