The Diagnostic Value of Biochemical and Tumour Markers in the Differential Diagnosis of Pleural Effusions: summary

Research output: Types of ThesisDoctoral Thesis

Abstract

The Doctoral Thesis was carried out at Rīga Stradiņš University Department of Internal Diseases. Defence: on 29 May 2020 at 15.00 online on Zoom meetings platform.Pleural effusion is a frequent complication of different diseases. Depending on pathogenetic mechanism, the effusion is divided into transudates and exudates. The most often cause of transudate is cardiac failure. The most frequent forms of exudates are parapneumonic pleuritis and malignant pleural effusion (MPE). Treatment and prognosis in pleural effusion of different etiology is different so definitive diagnose is very important. Diagnostics of malignant pleural effusion is not always simple, so additional diagnostics markers are still searched for. The theoretical part of the doctoral thesis summarizes and analyses the literature data in epidemiology, diagnostics and treatment of pleural effusion. The aim of the original study was to find out whether it is possible to improve the diagnostics of malignant pleural effusion by using of tumor or biochemical markers. To clarify the current situation and significance of the poblem, patients diagnosed with pleural effusion from 01.01.2010 to 31.12.2010 at Internal Diseses Departments of Riga East University Hospital were retrospectively reviewed. To find out the importance of additional biochemical and tumor markers in the diagnostics of MPE, patients with pleural effusion sequentially stationed from 08.08.2011 to 13.06.2014 in the Pulmonology Department of Internal Diseases Clinic of Riga East Clinical University Hospital “Gaiļezers” were prospectively analysed. In addition to routine examinations, B type natriuretic peptide (BNP), plasminogen activator inhibitor – 1 (PAI-1), carcinoembryonic antigen (CEA) and cancer carbohydrate antigen 125 (CA 125) levels in the pleural effusion and serum were analysed. Pleural effusion was diagnosed in 741 (4.6%) of retrospectively analysed patients. 47% of them were diagnosed with MPE, 29% - with cardiac hydrothorax and 19% - with parapneumonic pleuritis. The mortality rate of patients with pleural effusion was 3 times higher than mortality rate of all treated patients total (14.1% and 4.4% respectively). It was established that the examination methods for patients with pleural effusion were insufficient during the analysed period. 144 patients with pleural effusion were analysed prospectively. It was established that CA 125 level in patients with MPE is statistically higher both in pleural effusion and in serum hence CA 125 can serve as additional marker in diagnostics of MPE. Fibrinolytic system has significant role in pathogenesis of different pleural effusions. In case of parapneumonic pleuritis, fibrinolysis is delayed and loculated effusions occur, but in case of MPE loculation commonly doesn’t appear. Probably the treatment of pleural effusion of different etiology could be improved by influencing the fibrinolytic system. It was established that the level of PAI-1 in malignant pleural effusion was statistically significant lower that in case of parapneumonic pleuritis. This may indicate the trend of process spread in case of malignant diseases unlike the trend to loculate in case of parapneumonic pleuritis. An informative marker of cardiac hydrothorax is BNP in serum, but BNP in pleural effusion doesn’t provide any additional diagnostic information
Original languageEnglish
Supervisors/Advisors
  • Lejnieks, Aivars, First/Primary/Lead supervisor
  • Krams, Alvils, Second/Co-supervisor, External person
Place of PublicationRīga
Publisher
DOIs
Publication statusPublished - 2020

Keywords

  • Pneumonology

Field of Science

  • 3.2 Clinical medicine

Publication Type

  • 4. Doctoral Thesis

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