Chest
Volume 116, Issue 3, September 1999, Pages 760-765
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Laboratory and Animal Investigations
Vascular Endothelial Growth Factor in Pleural Fluid

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Study objectives

The purpose of this study was to analyze the relationship of the pleural fluid vascular endothelial growth factor (VEGF) level with the diagnostic category and with the pleural fluid characteristics in a group of 70 patients.

Design

The VEGF levels of consecutive patients undergoing therapeutic thoracentesis were determined with an enzyme-linked immunosorbent assay.

Setting

University-affiliated tertiary care center.

Results

The median level of pleural fluid VEGF in the patients with congestive heart failure (150 pg/mL) was significantly (p < 0.05) lower than the median level in the patients with coronary artery bypass grafting (357 pg/mL), which in turn was significantly lower (p < 0.05) than the median levels in the patients with malignancy (1,097 pg/mL). The overlap between groups, however, limits the diagnostic usefulness of pleural fluid VEGF levels. The VEGF level was most closely correlated with the lactate dehydrogenase level (r = 0.42, p < 0.001) and was also significantly correlated with the total pleural fluid protein level. The median VEGF levels in the pleural fluid of patients with breast cancer were significantly lower (p = 0.017) than in those with lung cancer. The VEGF level was very high (3,294 pg/mL) in the one patient with pulmonary embolism.

Conclusions

We conclude that the VEGF levels in pleural fluid differ significantly from one diagnostic category to another with the highest median levels occurring in patients with malignant pleural effusions. We speculate that VEGF may be responsible for the pleural fluid accumulation in at least some situations.

Section snippets

Materials and Methods

Between August 1, 1997, and January 30, 1998, we prospectively studied 70 consecutive patients who underwent thoracentesis under ultrasound guidance in the Department of Radiology. The study was approved by the Institutional Review Board of Saint Thomas Hospital, and before the thoracentesis all patients signed an informed consent.

Standard definitions were used for identifying the cause of the pleural effusion.14 A pleural effusion was said to be caused by congestive heart failure if the

Results

The diagnoses and the pleural fluid characteristics of the 70 patients studied are summarized in Table 1. The most common diagnosis, surprisingly, was pleural effusion after CABG. This hospital, however, performs > 2,500 CABG surgeries annually.

The distribution of the pleural fluid VEGF levels varied among groups (Fig 1). Patients with congestive heart failure had the lowest pleural fluid VEGF levels whereas the patients with malignancy had the highest levels, and the patients after CABG

Discussion

The results of the present study demonstrate that VEGF is present in pleural fluid with marked variation in its levels. The median level of VEGF in patients with congestive heart failure was significantly (p < 0.05) lower (150 pg/mL) than the median level in patients after CABG (357 pg/mL), which in turn was significantly (p < 0.05) lower than the median level in the patients with malignancy (1,097 pg/mL). Overall, there was much overlap in the pleural fluid VEGF levels from category to

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    Supported in part by Saint Thomas Foundation, Nashville, TN.

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