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Kim, Park, Park, Seo, Kim, Kim, Lee, Lee, Lee, Noh, Lee, Lee, Yong, and Shin: Diagnostic Value of Procalcitonin and C-Reactive Protein in Differentiation of Pleural Effusions
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2007; 63(4): 353-361.

Published online: 31 October 2007

DOI: https://doi.org/10.4046/trd.2007.63.4.353

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

Sang-Ha Kim, M.D.1, Joo Young Park, M.D.2, Hyun Sook Park, M.D.2, Hee Seok Seo, M.D.2, Shin Tae Kim, M.D.1, Chong Whan Kim, M.D.1, Bu Ghil Lee, M.D.1, Seok Jeong Lee, M.D.1, Shun Nyung Lee, M.D.1, Jin Kyu Noh, M.D.1, Min Su Lee, M.D.1, Won Yeon Lee, M.D.1, Suk Joong Yong, M.D.1, Kye Chul Shin, M.D.1

1Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

2Department of Microbiology, Yonsei University Wonju College of Medicine, Wonju, Korea.

Address for correspondence: Sang-Ha Kim, M.D. Department of Internal Medicine, Yonsei University Wonju College of Medicine, 162 Ilsan-dong, Wonju, Gangwon, Korea. Phone: 82-33-741-0926, Fax: 82-33-746-4667, sanghakim@yonsei.kr

Received 28 September 2007       Accepted 23 October 2007

Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases

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.

Keywords: Procalcitonin, C-Reactive Protein, Pleural Effusion, Malignant, Tuberculous

Figures and Tables

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.
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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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Table 1
Pleural leukocyte count, protein, LDH, ADA, ADA2, procalcitonin (PCT), and CRP in patients with pleural effusion
trd-63-353-i001

*Coronary artery bypass surgery, one; pulmonary thromboembolism, one; rheumatoid arthritis, one; uremic pleuritis, two; systemic lupus erythematosus, two.

Table 2
Procalcitonin (PCT) and CRP in patients with exudate and transudate
trd-63-353-i002

*p value < 0.05.

Table 3
PCT and CRP in patients with malignant and benign effusion
trd-63-353-i003

*p value<0.05, †tuberculous effusion, parapneumonic effusion, empyema, other benign effusions

Table 4
PCT and CRP in patient with tuberculous and nontuberculous effusion
trd-63-353-i004

*p value<0.05, †malignant effusion, parapneumonic effusion, empyema, other benign effusions.

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