Diagnosis of pulmonary embolism by use of urinary TNF alpha and its soluble TNF receptor I

The purpose of this clinical study was to determine the concentration of so luble tumor necrosis factor in urine of patients with pulmonary embolism (P E), verses voluntary control individuals. Sixteen patients (ages 24 to 74 y ears) with diagnosis of PE, documented by ventilation perfusion scan or pul monary angiogram, were the subjects of this study. Ten cc of urine was obta ined from each patient and subjected to a solid-phase enzyme-linked immunos orbent assay thus determining the soluble tumor necrosis factor (TNF) recep tor I (R I) and TNF alpha levels in these samples. In this pilot study of P E cases, a statistically significant elevation in urinary levels of TNF alp ha and soluble TNF R I was demonstrated in PE patients. The average urinary soluble TNF R I in normal subjects was 1,029 pg/mL and in PE patients the average TNF R I was 3,734.4 pg/mL. The clinical diagnosis of PE is a challenging problem for the physician. La te diagnosis and delayed management of this condition could be associated w ith massive PE. Although pulmonary angiography is the gold standard for dia gnosis of PE, it requires expensive equipment, trained radiologists, and th e patient could be at risk of sensitivity to contrast agents.