The Diagnostic Value of the Pleural Fluid C-Reactive Protein in Parapneumonic EffusionsReportar como inadecuado

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Disease Markers - Volume 2016 2016, Article ID 7539780, 6 pages -

Research Article

The Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, 49100 Petah Tikva, Israel

The Sackler Faculty of Medicine, Tel Aviv University, 69978 Tel Aviv, Israel

2nd Department of Medicine, Semmelweis University, Budapest 1088, Hungary

Mayanei HaYeshua Medical Center, 51544 Bnei Brak, Israel

Rambam Health Care Campus, 3109601 Haifa, Israel

Received 1 January 2016; Revised 27 February 2016; Accepted 20 March 2016

Academic Editor: Dennis W. T. Nilsen

Copyright © 2016 Shimon Izhakian et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. The aim of this study was to evaluate the sensitivity of pleural C-reactive protein CRP biomarker levels in identifying parapneumonic effusions. Methods. A single-center, retrospective review of 244 patients diagnosed with pleural effusions was initiated among patients at the Rabin Medical Center, Petah Tikva, Israel, between January 2011 and December 2013. The patients were categorized into 4 groups according to their type of pleural effusion as follows: heart failure, malignant, post-lung transplantation, and parapneumonic effusion. Results. The pleural CRP levels significantly differentiated the four groups with the following means: parapneumonic effusion,  mg-dL; lung transplant,  mg-dL; malignancy,  mg-dL; and heart failure,  mg-dL. The pleural fluid CRP cut-off value for differentiating among parapneumonic effusions and the other 3 groups was 1.38 mg-dL. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.2%, 71.5%, 37%, and 95%, respectively. A backward logistic regression model selected CRP as the single predictor of parapneumonic effusion OR = 1.59, 95% CI = 1.37–1.89. Conclusions. Pleural fluid CRP levels can be used to distinguish between parapneumonic effusions and other types of exudative effusions. CRP levels < 0.64 mg-dL are likely to indicate a pleural effusion from congestive heart failure, whereas levels ≥ 1.38 mg-dL are suggestive of an infectious etiology.

Autor: Shimon Izhakian, Walter G. Wasser, Benjamin D. Fox, Baruch Vainshelboim, and Mordechai R. Kramer



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