Pleural Fluid Procalcitonin Research Articles

Combined analysis of C-reactive protein in pleural fluid and serum is effective in the differential diagnosis of exudative pleural effusions.

BackgroundExudative pleural effusion (EPE) is one of the common pleural manifestations of various diseases. Differential diagnosis of EPE is imperative clinically as it identifies different causes of EPE, thereby, enabling effective treatments. Thoracoscopy is a useful tool for differential diagnosis of EPE; however, some patients refuse thoracoscopic examination due to its invasive nature. In addition, the specificity and sensitivity of existing routine tests of EPE are unsatisfactory. Therefore, there is a great need to establish an effective method for the differential diagnosis of EPE.MethodsThis study was a single-institution retrospective analysis of diagnostic efficiency of C-reactive protein (CRP) and procalcitonin (PCT) between March 2018 and September 2018. A total of 87 patients diagnosed with EPE were enrolled. All participants underwent diagnostic thoracentesis. The EPE was examined using biochemical, routine, microbiological, and cytological methods. Pathological cytology detection was necessary for those suspected of malignant PE. Benign PE originates in patients with pneumonia, empyema, and tuberculosis. The levels of CRP and PCT in EPE and serum were measured before treatment. Correlation analysis and receiver-operating characteristic (ROC) curve analysis were conducted to determine the underlying relationship between levels of CRP and PCT, and for differential diagnosis.ResultsThe ROC analysis showed that the sensitivity and specificity for the analysis of pleural fluid CRP (p-CRP) were higher (cut-off: 17.55 pg/mL; sensitivity: 75.00%, specificity: 83.90%) than that of serum CRP (s-CRP, cut-off: 23.90 pg/mL; sensitivity: 71.00%, specificity: 80.4%) in the differential diagnosis for EPE. However, the analysis of pleural fluid PCT (p-PCT) and serum PCT (s-PCT) did not demonstrate correlations with EPE. Combined analysis of p-CRP (cut-off: 17.55 mg/dL) with s-CRP (cut-off: 23.9 pg/mL) showed the highest diagnostic accuracy (88.4%) in diagnosing infectious EPE.ConclusionsThe data support the close relationship between combined analysis of p-CRP with s-CRP and effective and accurate differential diagnosis of EPE, due to its higher sensitivity and specificity. However, as a highly sensitive marker for diagnosing bacterial infections, neither s-PCT nor p-PCT, showed correlations with the differential diagnosis of EPE.

Efficacy of procalcitonin and pentraxin-3 as early biomarkers for differential diagnosis of pleural effusions.

ObjectivesPleural effusion, defined as an abnormal accumulation of fluid in pleural space, can be of two types: transudative and exudative. The primary aim of the study was to assess the predictive accuracy of procalcitonin (PCT) and pentraxin-3 (PTX-3) in comparison to other biochemical markers such as C-reactive protein (CRP), and adenosine deaminase (ADA) in the differential diagnosis of pleural effusions.MethodsA cross-sectional analytical study was conducted on patients with pleural effusion. Multiple comparisons and receiver-operating characteristics (ROC) analyses were made to evaluate the diagnostic significance of biochemical markers.ResultsSixty-six patients with exudative pleural effusion classified as malignant, tuberculous, and parapneumonic effusions (malignant pleural effusion [MPE], tuberculous [TPE], and parapneumonic [PPE]) were included. Significant differences in pleural fluid levels in both PCT (p-value: 0.001) and PTX-3(p-value: 0.001), as well as serum levels of PCT (p-value: 0.001), were observed between the three groups. ROC analysis showed both PTX-3 and PCT having favorable discrimination ability with high sensitivity (≥90%) and specificity to predict PPE from TPE and MPE.ConclusionsEvaluation of serum and pleural fluid PCT and levels of PTX-3 in the pleural fluid may be used as an early biomarker to differentiate the etiology of pleural effusion.

Determining The Etiological Factors in Pleural Fluid by Crp, Albumin And Procalcitonin Levels

Abstract 
 Aim: The Light criteria with a specificity of 72% and a sensitivity of 100% have led to further research into the detection of more specific diagnostic methods for transudate exudate separation. In this study, we aimed to evaluate whether pleural fluid and serum CRP, procalcitonin, on the other hand CRP / Albumin and Procalcitonin / Albumin ratios may be suggested as an alternative to Light criteria in the differential diagnosis of pleural effusions.
 
 Material and Method: In this study, the pleural effusions of 121 patients who were aged ≥18 years were evaluated. The study was planned as a prospective cohort type study.
 
 Results: Effusions were divided into two sub-groups as transudate (n:37) and exudate (n:84); and malignant (n:30) and non-malignant (n:91). Serum procalcitonin level of 0.035 was having a sensitivity of 0.726 and specificity of 0.964; on the other hand, pleural fluid procalcitonin level of 0.035 was having a sensitivity of 0.690 and specificity of 0.919. For serum procalcitonin /albumin ratio, 0.0104 value was having a sensitivity of 0.774 and specificity of 0.757 while for pleural fluid procalcitonin /albumin ratio of 0.019 value was having a sensitivity of 0.667 and specificity of 0.649.
 
 Conclusion: Serum and pleural fluid procalcitonin levels and procalcitonin/ albumin ratio were having a significant role in differentiating transudate and exudate. However, procalcitonin, CRP or any other ratios obtained from these parameters were not useful in diagnosis of malignant effusions.

The role of pleural fluid procalcitonin in the differential diagnosis in parapneumonic pleural effusions and its relation with the ultrasound image of the pleural fluid

The role of pleural fluid procalcitonin in the differential diagnosis in parapneumonic pleural effusions and its relation with the ultrasound image of the pleural fluid

The usefulness of pleural fluid presepsin, C-reactive protein, and procalcitonin in distinguishing different causes of pleural effusions

BackgroundWe aimed to determine the presepsin concentration in pleural fluid from patients with pleural effusions of different aetiologies and to compare its diagnostic value with that of pleural fluid C-reactive protein (CRP) and procalcitonin (PCT).MethodsWe enrolled 132 patients with pleural effusion who underwent diagnostic evaluation, and we classified them into six categories: empyema, parapneumonic effusion, tuberculous effusion, malignant effusion, paramalignant effusion, and transudate effusion. Additionally, all pleural effusions were categorised as infectious or non-infectious effusions.ResultsReceiver operating characteristic analysis was used to evaluate diagnostic performance. When diagnosing empyema, the marker with the highest sensitivity was pleural fluid presepsin (cut-off: 754 pg/mL; sensitivity: 90.9%, specificity: 74.4%) and that with the highest specificity was pleural fluid CRP (cut-off: 4.91 mg/dL; sensitivity: 63.6%, specificity: 89.3%). Pleural fluid PCT tended to be lower in patients with empyema than in those with parapneumonic effusion, but this was not useful for the diagnosis of empyema. When diagnosing infectious pleural effusion, a combination of pleural fluid CRP (cut-off: 2.59 mg/dL) and presepsin (cut-off: 680 pg/mL) produced the highest diagnostic accuracy (83.3%).ConclusionsPleural fluid presepsin was found at high levels in patients with empyema and parapneumonic effusion. This pattern closely resembles the previously reported pattern of pleural fluid CRP. Some combinations of pleural fluid inflammatory markers may be more clinically useful than these markers in isolation.

The role of procalcitonin in the management of pleural infection.

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.

Pleural fluid procalcitonin to distinguish infectious from noninfectious etiologies of pleural effusions.

In this study we investigate the diagnostic value of pleural fluid procalcitonin (PCT) in distinguishing infectious and noninfectious etiologies of pleural effusion. We reviewed the medical records of 75 hospitalized patients who underwent thoracentesis between 2011 and 2012. Data on pleural fluid lactate dehydrogenase (LDH), protein, albumin, cell count and differential, pH, Gram stain and culture, cytology, triglyceride, cholesterol, amylase, and PCT were collected. Data on serum LDH, protein, albumin, prothrombin time, normalized, and blood culture were also collected. Pleural effusions were classified into 2 groups, infectious and noninfectious. There were 18 infectious pleural effusions (IPE) and 57 noninfectious pleural effusions (NIPE). Median pleural fluid PCT was 1.088 ng/mL (0.312-2.940 ng/mL) in IPE and 0.123 ng/mL (0.05-0.263 ng/mL) in NIPE, with a P value < 0.0001. Pleural fluid PCT > 0.25 ng/mL had a sensitivity of 77.78% and specificity of 74.14% for diagnosing an IPE. A subgroup analysis of PCT in exudative infectious effusions versus exudative noninfectious malignant/paramalignant effusions showed higher levels in the former. PCT is a novel biomarker for diagnosing infectious pleural effusion, and it would be worthwhile to investigate the role of pleural PCT in assessing severity of illness, risk stratification, and antibiotic stewardship in hospitalized patients with pleural effusions. Journal of Hospital Medicine 2016;11:363-365. 2016 Society of Hospital Medicine.

Diagnostic value of procalcitonin and C-reactive protein in differentiation between some benign and malignant pleural effusions

Pleural effusion is relatively common clinical condition that requires differential diagnosis. It is defined as collection of fluid in pleural space. Pleural effusion is often diagnostic dilemma for the physician.The aim of the study was to assess the procalcitonin (PCT) and C-reactive protein (CRP) levels in serum and pleural fluid to evaluate their usefulness in the differentiation among benign and malignant pleural effusions.This study was conducted in Chest Department, Tanta University Hospital, it included 54 adult patients with pleural effusions of different etiologies, 8 transudative effusion, 14 para-pneumonic effusion, 14 tuberculous effusion and 18 malignant effusion. We measured serum and pleural procalcitonin and C-reactive protein by ELISA.The mean serum and pleural fluid procalcitonin (PCT) levels in parapneumonic effusions were significantly higher compared with transudative, tuberculous and malignant pleural effusions p<0.05. A significant positive correlation between serum and pleural fluid PCT levels was observed in the studied groups. The mean serum and pleural fluid CRP concentration were significantly lower in malignant and transudative pleural effusion than tuberculous and para-pneumonic effusion p<0.05.Significant positive correlation between serum and pleural fluid CRP levels was observed in the studied groups. Procalcitonin levels in serum and pleural effusion were significantly lower in malignant effusion compared to para-pneumonic pleural effusion and CRP levels were significantly lower compared to other types of exudative pleural effusion.

Diagnostic value of pleural fluid and serum procalcitonin levels in the diagnosis of parapneumonic pleural effusion

To determine the diagnostic value of pleural fluid procalcitonin (PF-PCT) and serum PCT (S-PCT) levels in the diagnosis of parapneumonic pleural effusion (PPPE). Sixty five inpatients with exudative pleural fluid were consecutively included in this prospective study. Biochemical (total protein, albumin, LDH, glucose, pH, PCT) studies were performed in concurrently obtained pleural fluid and venous blood samples, cytologic and microbiologic (acid-fast bacillus smear/culture, nonspecific bacterial Gram stain/culture, fungal culture) studies were performed in pleural fluid. The patients were grouped as PPPE (n= 33) and non-PPPE (n= 32) after the diagnoses were definitely established. A total of 65 patients (M/F: 38/27; age: 57.53 ± 18.46 years) with exudative pleural fluids were assessed. In the 33 with PPPEs, 6 simple PPPEs, 5 complicated PPPEs and 22 empyemas were determined whereas in the 32 non-PPPEs, 9 tuberculous, 10 malignant, 6 paramalignant, 5 non-specific effusions and 2 chylothoraces were determined. Compared with the non-PPPE group, more fever, pneumonic infiltrations and fluid loculation, higher sedimentation, leukocyte, fluid LDH besides lower fluid glucose, pH, albumin and protein together with lower serum LDH were determined in the PPPE group (p< 0.05). Higher PS-PCT (1.03 ± 1.27 vs. 0.06 ± 0.06 ng/mL) and S-PCT levels (0.90 ± 1.44 vs. 0.05 ± 0.02 ng/mL) were determined in the PPPE group (p= 0.000). In the PPPE group, PS-PCT and S-PCT showed positive correlation with each other while PS-PCT did with sedimentation, leukocyte, CURB-65 and serum LDH, and S-PCT did with sedimentation, CURB-65 and duration of hospitalization. ROC curve, a specificity of 96.9% and a sensitivity of 57.5% were determined for an optimal PS-PCT cut-off level (0.285 ng/mL), and a specificity of %96.9 and a sensitivity of %66.6 for an optimal S-PCT cut-off level (0.105 ng/mL) that could differentiate PPPE. PS/S-PCT levels were found to be highly efficient in excluding PPPE but not sufficiently reliable in the diagnosis of it. However, these findings should be reassessed in a larger group of cases that have not been given any antibiotic/anti-inflammatory treatment.

Procalcitonin as a diagnostic marker in differentiating parapneumonic effusion from tuberculous pleurisy or malignant effusion

ObjectivesDifferential diagnosis of exudative pleural effusions can be difficult, despite the use of several biomarkers. Serum procalcitonin (s-PCT) is a well-known biomarker for systemic bacterial infections. However, the usefulness of pleural fluid procalcitonin (pf-PCT) in clinical practice has not been established. This study evaluated the usefulness of PCT measurements in differentiating parapneumonic effusion (PPE) from tuberculous (TB) pleurisy or malignant effusion. Design and methodsNinety eight adult patients diagnosed with exudative pleural effusion were enrolled and allocated into the PPE group (n=32), TB pleurisy group (n=40), or malignant effusion group (n=26). Both s-PCT and pf-PCT concentrations were measured at admission using an immunoluminometric assay. ResultsBoth s-PCT and pf-PCT were significantly increased in the PPE group compared with the TB pleurisy or malignant effusion groups (p<0.001). The optimal cut-off value for s-PCT in the diagnosis of PPE was 0.18ng/mL (sensitivity 83.3%, specificity 81.0%). The pf-PCT cut-off value was 0.16ng/mL (sensitivity 81.5%, specificity 72.1%). Serum PCT exhibited better diagnostic accuracy than pf-PCT, with areas under the receiver operating characteristic curves of 0.842 for s-PCT and 0.784 for pf-PCT (p=0.015). In addition, s-PCT and pf-PCT showed better diagnostic accuracy than serum C-reactive protein (p=0.005 and p=0.023, respectively). ConclusionsMeasurement of s-PCT and pf-PCT is useful in differentiating PPE from TB pleurisy and malignant effusion. Both s-PCT and pf-PCT may be useful biomarkers in the differential diagnosis of exudative pleural effusions.

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Introduction: Exudative pleural effusion is formed in half of the malignancies in which diagnosis of the cause appears necessary Hypothesis: We embarked on whether pleural effusion procalcitonin (PCT) level as a biomarker could have clinical and statistical significance in diagnosis of malignant pleural effusion Methods: Pleural fluid PCT concentrations were measured prospectively in 106 patients with exudative pleural effusion Results: procalcitonin level was the only significantly different marker in pleural effusion between malignant and non-malignant group. Using a ROC curve, the area under curve (AUC) for exudative pleural fluid procalcitonin level in malignancies was 0.717 with 95% CI of 0.618-0.818 and p-value of 0.0005. Malignancy group had a statistical significant AUC compare to non-malignant group. By using Youden index the best cut-off point for maximum sensitivity and specificity was determined as 0.52 ng/dl Conclusions: pro-calcitonin (PCT) can be more accurate, efficient, specific and useful in diagnosing malignancies exudative PE than current modules.

The Role of Pleural Fluid Procalcitonin Level in the Diagnosis of Parapneumonic Pleural Effusion

The Role of Pleural Fluid Procalcitonin Level in the Diagnosis of Parapneumonic Pleural Effusion

The use of pleural fluid procalcitonin and C-reactive protein in the diagnosis of parapneumonic pleural effusions: a systemic review and meta-analysis

BackgroundWe aimed to perform a systematic review and meta-analysis of the diagnostic performance of pleural fluid procalcitonin (PCT) or C-reactive protein (CRP) in differentiating parapneumonic effusion in patients with pleural effusion. MethodsWe searched the EMBASE, MEDLINE, and Cochrane database in December 2011. Original studies that reported the diagnostic performance of PCT alone or compared with that of other biomarkers for differentiating the characteristics of pleural effusion were included. ResultsWe found 6 qualifying studies including 780 patients with suspected parapneumonic effusion and 306 confirmed cases of parapneumonic effusion. Six studies examined the diagnostic performance of pleural fluid PCT, 3 also tested for serum PCT, and another 3 tested for serum CRP. The bivariate pooled sensitivity and specificity were as follows 0.67 (95% confidence interval [CI], 0.54-0.78) and 0.70 (95% CI, 0.63-0.76), respectively, for pleural fluid PCT; 0.65 (95% CI, 0.55-0.74) and 0.68 (95% CI, 0.62-0.74), respectively, for serum PCT; and 0.54 (95% CI, 0.47-0.61) and 0.77 (95% CI, 0.72-0.81), respectively, for serum CRP. There was evidence of significant heterogeneity (I2=55.0%) for pleural fluid or serum PCT but not for CRP (I2=0.0%). ConclusionThe existing literature suggests that both pleural fluid and serum PCT tests have low sensitivity and specificity for differentiating parapneumonic effusion from other etiologies of pleural effusion. Compared with PCT, serum CRP has higher specificity and a higher positive likelihood ratio, and thus, it has a higher rule-in value than PCT.

Procalcitonin, C-Reactive Protein, and Cell Counts in the Diagnosis of Parapneumonic Pleural Effusions

Background and ObjectivePleural effusion is relatively common in pneumonia. Because traditional methods for its diagnosis are not always effective, there is a need for new biomarkers to make its differential...

P63 A prospective observational trial examining the diagnostic utility of serum and pleural fluid procalcitonin in the initial investigation of unilateral pleural effusions

Differentiation of pleural infection from other causes of pleural effusion, particularly pleural malignancy can be difficult. Clinical features and readily available tests are non-specific resulting in early over-diagnosis of pleural...

Serum and Pleural Fluid Procalcitonin in Predicting Bacterial Infection in Patients with Parapneumonic Effusion

This study evaluated the value of procalcitonin (PCT) levels in pleural effusion to differentiate the etiology of parapneumonic effusion (PPE). Forty-one consecutive PPE patients were enrolled and were divided into bacterial and non-bacterial PPE. Blood and pleural effusion samples were collected for PCT measurement on admission and analyzed for diagnostic evaluation. PCT of pleural fluid was significantly increased in the bacterial PPE group (0.24 ng/mL) compared to the non-bacterial PPE group (0.09 ng/mL), but there was no significant difference for serum PCT. A PCT concentration of pleural fluid >0.174 ng/mL (best cut-off value) was considered positive for a diagnosis of bacterial PPE (sensitivity, 80%; specificity, 76%; AUC, 0.84). Pleural effusion PCT in the bacterial PPE is significantly different from those of the non-bacterial PPE and control groups, so the diagnostic use of PCT still warrants further investigation.

Pleural fluid and serum procalcitonin as diagnostic tools in tuberculous pleurisy

Background: Diagnosis of tuberculous pleuritis is difficult because of its nonspecific clinical presentation and decreased efficiency of traditional diagnostic methods. We investigated the use of procalcitonin (PCT) concentration in tuberculous pleuritis diagnosis. Methods: A prospective clinical study was performed with two different patient groups. A total of 28 patients were included: 18 with tuberculosis and 10 with nontuberculous pleurisy. Serum and pleural fluid PCT concentrations were evaluated before treatment. Results: Serum and pleural fluid PCT concentrations were statistically different between tuberculous and nontuberculous pleurisy groups ( P = 0.012 and P = 0.004, respectively), even though they were not elevated in relation to the cut-off level of 0.5 ng/mL. A positive and significant correlation was detected between serum and pleural fluid PCT levels ( r = 0.49, P = 0.008). Diagnostic specificity and sensitivity values for serum and pleural fluid PCT in discriminating tuberculous from nontuberculous pleurisy were 80% and 72.2%, and 90% and 66.7% at the 0.081 and 0.113 ng/mL cut-off values, respectively. Conclusion: Relative to the current cut-off level of 0.5 ng/mL, PCT concentration is not a useful parameter for the diagnosis of tuberculous pleurisy. Because there were PCT levels in patients with tuberculous pleurisy that were below the current cut-off level but were significantly different from those of the nontuberculous group, the use of PCT should be further investigated.