Key result
Higher pericardial IFN-γ levels correlate positively with pericardial effusion size and tamponade severity.
Why the study?
Tuberculous pericarditis accounts for 60% of pericarditis cases in Africa, and the correlation between pericardial disease severity and cytokine expression in blood and pericardial fluid required evaluation.
Do pericardial fluid and blood cytokine expression levels correlate with pericardial disease severity in patients with tuberculous pericarditis?
Cohort (n=44)
Do pericardial fluid and blood cytokine expression levels correlate with pericardial disease severity in patients with tuberculous pericarditis?
In tuberculous pericarditis, a stronger local TH1-type pro-inflammatory immune response (specifically pericardial IFN-γ) is directly associated with greater clinical disease severity and effusion size.
Objective: Tuberculous pericarditis accounts for 60% of all cases of pericarditis in Africa. We aimed to correlate pericardial disease severity with cytokine expression from blood and pericardial fluid in patients with tuberculous pericarditis. Methods: 44 patients presenting with tuberculous pericardial effusions (PE) were prospectively recruited in Cape Town, Rep South Africa. Enzyme-linked immunosorbent assays were performed on PE and serum samples for the following cytokines: TNF, IFN-γ, IL-10, IL-1β, and TGF-β. Correlations were ascertained between PE and serum cytokine levels and clinical data indicative of ventricular dysfunction and pericardial disease severity such as ejection fraction, NYHA-stage, right atrial pressure, effusion size, degree of arterial paradox, E/A-ratio, opening pressure at pericardiocentesis and left ventricular shortening fraction (LVSF). Results: Levels of the pro-inflammatory cytokines (IFN-γ, TNF, IL-1β) were higher in PE compared to serum while levels of the anti-inflammatory cytokines (TGF-β and IL-10) were higher in serum than in PE. The serum concentration of TGF-β was higher in HIV infected patients compared to HIV uninfected patients (p=0.0007). There was a positive correlation between the pericardial IFN-γ level and PE size, atrial pressure and degree of arterial paradox. Of these the strongest correlation was with effusion size (Spearman r=0.47, p=0.0024). Discussion: In tuberculous pericarditis the magnitude of the TH1-type immune response against Mycobacterium tuberculosis is associated with the severity of the clinical pericardial disease.
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Wolske et al. (2008) conducted a cohort in Tuberculous pericardial effusions (pericardial tuberculosis) (n=44). Pericardial effusion and serum cytokine levels (TNF, IFN-γ, IL-10, IL-1β, TGF-β) was evaluated on Correlation between cytokine levels and clinical indicators of pericardial disease severity (specifically effusion size) (Spearman r=0.47, p=0.0024). Pericardial IFN-γ levels correlated positively with pericardial effusion size, right atrial pressure, and arterial paradox, most strongly with effusion size (Spearman r=0.47, p=0.0024).
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