Pleural Fluid Biomarkers of Pediatric Parapneumonic Effusion

Background/Objectives: Parapneumonic pleural effusion (PPE) secondary to community-acquired pneumonia is the most common cause of pediatric pleural effusion. This study aimed to evaluate the pleural fluid characteristics of pediatric patients with PPE and to compare biomarkers between infants (1-12 months) and children (1-14 years). Methods: Fifty-four pediatric patients (14 infants and 40 children) with PPE were included. Pleural fluid samples were analyzed for white blood cell (WBC) count, glucose, total protein, lactate dehydrogenase (LDH), adenosine deaminase (ADA), and pH levels. Differences between age groups and correlations between age and pleural fluid biomarkers were assessed. Results: Most pediatric PPE cases exhibited biochemical characteristics consistent with pleural exudate: WBC > 1000 cells/µL, total protein > 3 g/dL, LDH > 200 U/L. Infants showed a predominance of mononuclear WBC, while children exhibited a predominance of polymorphonuclear WBC. Glucose levels were higher, and total protein levels were lower in infants compared to children. Age was positively correlated with polymorphonuclear WBC percentage (rho = 0.509, p < 0.001) and protein levels (rho = 0.622, p < 0.001), whereas glucose levels were negatively correlated with age (rho = -0.274, p = 0.043). Conclusions: Age-specific differences in pleural fluid biomarkers were observed in pediatric patients with PPE, suggesting a more robust and acute inflammatory response in children compared to infants. These findings underscore the importance of considering age-related variations in the inflammatory response when diagnosing and managing PPE in pediatric populations.