The role of procalcitonin in the management of pleural infection.

Abstract

Pleural infection is a common problem associated with significant morbidity and mortality. Systemic or pleural fluid markers for reliably identifying pleural infection are limited. Procalcitonin (PCT) is known to be elevated in bacterial infection and is currently used for diagnosis and decision-making regarding antibiotic duration in respiratory infections. This review investigates if there is a role for serum and pleural fluid PCT (pf-PCT) in diagnosis and management of pleural infection. Studies investigating the role of PCT have been limited by small patient numbers and heterogenous control populations. Overall, serum PCT (s-PCT) does not have a role superior to that of C-reactive protein (CRP) or leucocyte count (LCC) in diagnosing pleural infection or monitoring response to treatment. Similarly, pf-PCT demonstrated low sensitivity and specificity for diagnosing pleural infection. There was no role for PCT in determining which patients would require surgery as opposed to tube drainage alone. There is currently insufficient evidence to recommend routine use of PCT for diagnosis and monitoring of pleural infection.