Can intrapleural C-reactive protein predict VATS pleurodesis failure?
BACKGROUND
Intrapleural inflammatory reaction after surgery for spontaneous pneumothorax is a key indicator whether an effective pleurodesis has been achieved. In this study, we tested the hypothesis that intrapleural C-reactive protein (CRP) might precisely quantify the postoperative pleural inflammation, offering potentially useful information for patient management.


METHODS
The study population consisted of 75 consecutive patients who underwent video-assisted thoracoscopic pleurectomy or pleural abrasion for spontaneous pneumothorax between April 2003 and August 2004. We assessed CRP levels in pleural and blood samples taken daily in the first 4 postoperative days.


RESULTS
Intrapleural CRP profile was significantly lower in patients who underwent pleural abrasion, in younger patients (< 25 years) and in patients who were not drained before surgery. Patients with pleurodesis failure had a lower CRP peak with a delayed peak. Receiving operating characteristics (ROC) analysis showed that the cutoff value of intrapleural CRP for pleurodesis failure was 25 mg/l on the second postoperative day (sensitivity 87.5 %, specificity 66.6 %, positive predictive value 24.1, negative predictive value 97.7 %).


CONCLUSIONS
Pleural CRP levels of less than 25 mg/l on the second postoperative day indicate only a moderate pleural inflammation.
Leo
F
F
Thoracic Surgery Department, Pasteur Hospital, University Hospital of Nice, Nice, France. francesco.leo@ieo.it
Vénissac
N
N
Pop
D
D
Rosenthal-Allieri
A
A
Mouroux
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018700:Pleurodesis; D011030:Pneumothorax / Q000601:surgery* / Q000628:therapy; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D020775:Thoracic Surgery, Video-Assisted; D017211:Treatment Failure
D015415:Biomarkers; D002097:C-Reactive Protein