Tuberc Respir Dis.  2007 Oct;63(4):353-361.

Diagnostic Value of Procalcitonin and C-Reactive Protein in Differentiation of Pleural Effusions

• Kim SH
• Park JY
• Park HS
• Seo HS
• Kim ST
• Kim CW
• Lee BG
• Lee SJ
• Lee SN
• Noh JK
• Lee MS
• Lee WY
• Yong SJ
• Shin KC

Abstract

BACKGROUND: Malignancies are a common and important causes of exudative pleural effusions. Several tumor markers have been studied because the pleural fluid cytology and pleural biopsy specimens do not provide a diagnosis in a high percentage of malignant effusions. In an attempt to overcome this limitation, procalcitonin and C-reactive protein (CRP) in pleural effusions and serum, which are known to be inflammation markers, were measured to determine if they can differentiate an exudate from trasndate as well as the diverse causes of exudative pleural effusion.
METHODS
178 consecutive patients with pleural effusion (malignant 57, tuberculous 51, parapneumonic 31, empyema 5, miscellaneous benign 7, transudative 27)were studied prospectively. The standard parameters of pleural effusion and measured serum and pleural procalcitonin were examined using in immunoluminometric assay. The level of CRP in serum and pleural fluid was determined by turbidimetric immunoassay.
RESULTS
The pleural procalcitonin levels in the exudate were significantly higher than those in the transudate, 0.81+/-3.09 ng/mL and 0.12+/-0.12 ng/mL, respectively (p=0.007). The pleural CRP levels were significantly higher in the exudate than the transudate, 2.83+/-3.31 mg/dL and 0.74+/-0.67 mg/dL, respectively (p<0.001). The pleural procalcitonin levels in the benign effusion were significantly higher than those in the malignant effusion, 1.15+/-3.82 ng/mL and 0.25+/-0.92 ng/mL, respectively (p=0.032). The pleural CRP levels were significantly higher in the benign effusion than in the malignant effusion, 3.68+/-3.78 mg/dL and 1.42+/-1.54 mg/dL, respectively (p<0.001). The pleural procalcitonin levels in the non-tuberculous effusion were significantly higher than those in the tuberculous effusion, 1.16+/-3.75 ng/mL and 0.13+/-0.37 ng/mL, respectively (p=0.008).
CONCLUSION
Measuring the level of procalcitonin and CRP in the pleural fluid is helpful for differentiating between transudates and exudates. In addition, it is useful for differentiating between benign and malignant pleural effusions.

Keyword

Procalcitonin; C-Reactive Protein; Pleural Effusion; Malignant; Tuberculous

MeSH Terms

Biopsy
C-Reactive Protein*
Diagnosis
Empyema
Exudates and Transudates
Humans
Immunoassay
Inflammation
Pleural Effusion*
Pleural Effusion, Malignant
Prospective Studies
Biomarkers, Tumor
C-Reactive Protein

Figure

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  Figure 1 Receiver operating characteristic curve of pleural fluid C-reactive protein (CRP) concentrations for discriminating exudate from transudate. The area under the curve value was 0.752 (p=0.0001). Specificity and sensitivity value for pleural fluid CRP were 96.3% and 45.0% at the 2.06 mg/dL cut-off value.

• 

  Figure 2 Receiver operating characteristic curves of pleural fluid C-reactive protein (CRP) and procalcitonin (PCT) concentrations for discriminating benign effusions from malignant effusions. The area under the curve values were 0.729 and 0.591, respectively. Specificity and sensitivity values for pleural fluid CRP and PCT were 86.0% and 53.2%, and 84.2% and 40.4% at the 2.28 mg/dL and 0.11 ng/mL cut-off values, respectively.

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