Diagnostic value of pleural C-reactive protein levels in assessing severity of pediatric parapneumonic effusions

Abstract

The immediate determination of complicated parapneumonic effusion is featured by instant remedial advantages. Consequently, we attempted to evaluate whether C-reactive protein (CRP) in pleural fluid can ameliorate the identification of cases with parapneumonic effusions that eventually require intervention. Patients and methods. A case-control study enrolled 43 patients with parapneumonic effusions from the inpatient ward and emergency room of Ain Shams Pediatric University Hospital, Egypt. Twenty of those patients had complicated effusions (complicated parapneumonic pleural effusion, CPPE), and 23 had uncomplicated parapneumonic pleural effusions (UCPPE). The differentiation characteristics of pleural fluid biochemical parameters as well as pleural CRP were estimated. Pleural fluid parameters were applied to classify cases of CPPE or UCPPE. ROC analysis established CRP setting to distinguish between both groups. Results. Pleural CRP was significantly higher in CPPE and empyema (48.97 mg/L) than in UCPPE (7.75 mg/L). The optimal cut-off point between CPPE and UCPPE in relation to pleural CRP was found to be 12.26 mg/L with a sensitivity of 95.00%, specificity of 95.65%, and AUC of 94.8%. Conclusion. Pleural fluid CRP can indeed be a beneficial spare test in pleural effusions and contribute to the differential diagnosis of CPPE and UCPPE. Key words: parapneumonic effusion, empyema, pleural CRP, pediatrics