Pleural fluid C-reactive protein contributes to the diagnosis and assessment of severity of parapneumonic effusions.
OBJECTIVE
Prompt identification of parapneumonic effusions has immediate therapeutic benefits. We aimed to assess whether C-reactive protein (CRP) and routine biochemistries in pleural fluid are accurate markers of parapneumonic effusions, and to evaluate their properties as indicators for drainage (complicated parapneumonic effusion).


METHODS
A retrospective review of 340 non-purulent parapneumonic effusions and 1,659 non-parapneumonic exudates from a single center was performed and the discriminative properties of pleural fluid routine biochemistries and, when available, CRP were evaluated. CRP, along with classical fluid parameters, was also applied to classify patients as having complicated or uncomplicated parapneumonic effusions. ROC analysis established the threshold of CRP for discriminating between groups.


RESULTS
Pleural fluids with neutrophilic predominance and CRP levels >45 mg/dL were most likely to be parapneumonic in origin (likelihood ratio=7.7). When attempting to differentiate non-purulent complicated from uncomplicated effusions, a CRP >100mg/L had the same performance characteristics (area under the curve=0.81) as the widely accepted biochemistries pH and glucose. Combinations of CRP with pH or glucose resulted in incrementally discriminating values, pertaining to either sensitivity (75-80%) or specificity (97%), for complicated effusions.


CONCLUSIONS
Pleural fluid CRP may be a useful adjunctive test in pleural effusions, both as a marker of parapneumonics and, particularly, as a differentiator between complicated and uncomplicated effusions.
Pleural Diseases Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain. jporcelp@yahoo.es
José M
JM
Porcel
Silvia
S
Bielsa
Aureli
A
Esquerda
Agustín
A
Ruiz-González
Miquel
M
Falguera
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D005122:Exudates and Transudates / Q000737:chemistry*; D006801:Humans; D008875:Middle Aged; D010996:Pleural Effusion / Q000175:diagnosis*; D012189:Retrospective Studies; D012720:Severity of Illness Index
D002097:C-Reactive Protein