A simple C‐reactive protein measurement for the differentiation between tuberculous and malignant pleural effusion

Chierakul, Nitipatana; Kanitsap, Apichart; Chaiprasert, Angkana; Viriyataveekul, Ronnachai

doi:10.1111/j.1440-1843.2003.00521.x

Cited by 39 publications

(27 citation statements)

References 11 publications

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“…We showed that a pleural fluid CRP level .80 mg?L -1 argues for the presence of a PPE (LR+ 7.4), whereas CRP levels ,20 mg?L -1 are a strong indicator against an infectious pleural effusion, whether of bacterial or mycobacterial nature (LR-0.22). Indeed, a number of studies provide support for the use of CRP as a diagnostic aid in tuberculous pleuritis; low pleural CRP levels (,30 mg?L -1 ) make this diagnosis unlikely while being more indicative of a malignancy in patients with exudates [8][9][10]. In addition, our findings complement the scarce previous literature on the application of CRP for identifying CPPE [11,12].…”

Section: Discriminating Ppe From Other Aetiologiessupporting

confidence: 70%

Biomarkers of infection for the differential diagnosis of pleural effusions

Porcel

Vives²,

Cao³

et al. 2009

Eur Respir J

103

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We aimed to investigate whether pleural fluid concentrations of biomarkers for bacterial infection, namely triggering receptor expressed on myeloid cells (sTREM-1), procalcitonin (PCT), lipopolysaccharide-binding protein (LBP) and C-reactive protein (CRP), might identify infectious effusions and discriminate between complicated (CPPEs) and uncomplicated parapneumonic effusions (UPPEs).Stored pleural fluid samples from 308 patients with different causes of pleural effusion were used to measure the four biomarkers. Receiver-operating characteristic analysis determined the accuracy of the new tests.Median pleural fluid levels of CRP, sTREM-1 and LBP were significantly higher in CPPE compared with those in other aetiologies. The area under the curve for distinguishing infectious (parapneumonics and tuberculosis) from noninfectious effusions was 0.87 for CRP, 0.86 for sTREM-1, 0.57 for PCT and 0.87 for LBP. Regarding the discrimination of nonpurulent CPPE versus UPPE, a multivariate analysis found that pleural fluid glucose f60 mg?dL -1 , LBP o17 mg?mL -1 and CRP o80 mg?L -1 were the best parameters. Individually, none of the new biomarkers achieved better performance characteristics than pH, glucose or lactate dehydrogenase in labelling CPPE.In conclusion, elevated pleural fluid levels of CRP, sTREM and LBP identify patients with infectious effusions, particularly those with CPPE. PCT has no value for the differential diagnosis of pleural effusions.

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Section: Discriminating Ppe From Other Aetiologiessupporting

confidence: 70%

Biomarkers of infection for the differential diagnosis of pleural effusions

Porcel

Vives²,

Cao³

et al. 2009

Eur Respir J

103

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“…They found that with a cut-off level of CRP ≥30 mg/l, sensitivity was 72 and specificity 93%. However, in the study by Chierakul et al [26], pleural effusions due to other origins were excluded.…”

Section: Discussionmentioning

confidence: 99%

“…In one study [23], the authors found that CRP levels were significantly higher in parapneumonic and tuberculous effusions, and our group [14] reported previously that in pleural exudates a CRP <20 mg/l suggests a malignant origin, whereas a level >45 mg/l virtually ruled out this possibility. Very recently, Chierakul et al [26] studied CRP in 55 patients with tuberculous pleuritis and in 60 patients with malignant pleural effusions. They found that with a cut-off level of CRP ≥30 mg/l, sensitivity was 72 and specificity 93%.…”

Section: Discussionmentioning

confidence: 99%

C-Reactive Protein in Lymphocytic Pleural Effusions: A Diagnostic Aid in Tuberculous Pleuritis

García-Pachón

Soler²,

Padilla-Navas³

et al. 2005

Respiration

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Background:C-reactive protein (CRP) pleural fluid levels have been found to be higher in tuberculosis and parapneumonic effusions than in other causes of pleural effusion. Objective:The aim of this study was to analyze whether CRP (a simple and inexpensive test) may be a diagnostic aid for tuberculosis in lymphocytic pleural effusions. Methods:One hundred and forty-four patients with a lymphocytic pleural effusion (more than 50% lymphocytes in the differential white blood cell count) were included. The patients were 93 men (65%) and 51 women (35%), aged 64 ± 18 years (mean ± SD). The diagnoses were as follows: tuberculosis, 20; pleural effusion associated with malignancy, 69; transudates, 38; other benign exudates, 17. Results: The CRP pleural fluid level was higher in tuberculous pleuritis (54 ± 24 mg/l) than in lymphocytic effusions of other origin (21 ± 16 mg/l; p < 0.001). High CRP levels (≧50 mg/l) have a high specificity for tuberculosis (95%), and low levels (<30 mg/l) have a high sensitivity (95%) for excluding disease. Conclusions: CRP pleural fluid level determination is useful in the diagnostic workup of lymphocytic pleural effusions. High CRP levels are very suggestive of tuberculous pleuritis, and low CRP levels make this diagnosis unlikely.

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“…Higher SF CRP levels reXect greater degrees of joints inXammation in RA and OA [16]. CRP level is also used for the diVerentiation of infectious, tuberculosis and malignant pleural eVusions [17,18].…”

Section: Introductionmentioning

confidence: 99%

Synovial fluid adenosine deaminase and high-sensitivity C-reactive protein activity in differentiating monoarthritis

2010

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It is proposed that synovial fluid biomarkers may help in differentiating the type of arthritis. The aim of study is to determine whether synovial fluid adenosine deaminase (ADA) and high-sensitivity C-reactive protein (hs-CRP) can be useful in this regard. A total of 75 patients with knee monoarthritis that were admitted in Shahid Beheshti Kashan hospital in 2009 included in the study. There were 18 rheumatoid arthritis, 13 crystal-induced arthritis, 3 septic arthritis and 41 osteoarthritis. Inflammatory arthritis was diagnosed if more than 2,000 white blood cells existed in per milliliter of the synovial fluid. There was statistically significant difference in mean synovial fluid ADA and hs-CRP concentration between inflammatory (26.06 ± 8.96 IU/l, 12.72 ± 9.25 μg/ml) and non-inflammatory arthritis (14.8 ± 2.79 IU/l, 2.36 ± 2.7 μg/ml) (P values = 0.00, 0.00). There was statistically significant difference in mean synovial fluid ADA and hs-CRP concentration when rheumatoid arthritis (23.77 ± 4.58 IU/l, 10.47 ± 6.99 μg/ml), crystal-induced arthritis (22.76 ± 3.65 IU/l, 14.37 ± 11.58 μg/ml) and septic arthritis (49.66 ± 8.96 IU/l, 18.25 ± 5.37 μg/ml) were compared with osteoarthritis (14.58 ± 2.63 IU/l, 1.91 ± 1.31 μg/ml) (All P values = 0.00). There was statistically significant difference in mean synovial fluid ADA concentration between septic and rheumatoid arthritis and also between septic arthritis and crystal-induced arthritis (P values = 0.00, 0.00). This study showed that synovial fluid ADA and hs-CRP can properly differentiate inflammatory from non-inflammatory arthritis. Synovial fluid ADA is a useful marker in differentiating septic from rheumatoid and crystal-induced arthritis.

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A simple C‐reactive protein measurement for the differentiation between tuberculous and malignant pleural effusion

Abstract: In patients presenting with lymphocytic exudative pleural effusion, a simple marker of raised pleural fluid CRP level may be helpful in discriminating between TBP and MPE.

Cited by 39 publications

References 11 publications

Biomarkers of infection for the differential diagnosis of pleural effusions

Biomarkers of infection for the differential diagnosis of pleural effusions

C-Reactive Protein in Lymphocytic Pleural Effusions: A Diagnostic Aid in Tuberculous Pleuritis

Synovial fluid adenosine deaminase and high-sensitivity C-reactive protein activity in differentiating monoarthritis

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