Prognostic importance of serial cytokine changes in ascites and pleural effusion in women with severe ovarian hyperstimulation syndrome

Objective: To determine the prognostic value of various cytokine levels in ascites and pleural effusion during the evolution of severe ovarian hyperstimulation syndrome (OHSS). Design: A longitudinal study. Setting: University teaching hospital. Patient(s): Twenty patients with severe OHSS who required either paracentesis or thoracentesis or both from whom ascites (n = 56) or pleural effusion (n = 12) samples were obtained. Control peritoneal fluid was obtained from 20 patients undergoing ovarian stimulation for IVF. Intervention(s): Abdominal paracentesis for tense ascites and thoracentesis for massive pleural effusion. Control peritoneal fluid was obtained before oocyte retrieval. Main Outcome Measure(s): Levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), E₂, and progesterone concentrations in ascites and pleural effusion. Result(s): Levels of VEGF and IL-6 in ascites dropped significantly during the course of OHSS and were not correlated with E₂ concentrations. Levels of VEGF were significantly correlated with levels of IL-1β, IL-8, and TNF-α, as well as progesterone concentrations, hematocrit, and white blood cell counts. None of the cytokine levels measured in pleural effusion were correlated with the course of OHSS. Conclusion(s): These results suggest that local cytokines might be involved in the evolution of severe OHSS and possibly serve as prognostic markers for this syndrome.