Chest
Volume 136, Issue 1, July 2009, Pages 205-211
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Original Research
Pleural Effusions
Diagnostic and Prognostic Values of Pleural Fluid Procalcitonin in Parapneumonic Pleural Effusions

https://doi.org/10.1378/chest.08-1134Get rights and content

Background

The role of procalcitonin in parapneumonic pleural effusion (PPPE) as a diagnostic and prognostic biomarker of the outcome has not been examined before.

Methods

From the emergency department, 82 adult patients with pleural effusions were enrolled in this prospective study and divided into the following two groups: the PPPE group (n = 45); and the non-PPPE group (n = 37). Levels of pleural fluid (PF) PCT and serum (S) PCT were determined in all patients after study enrollment as well as on day 3 only in the PPPE group by a newly developed time-resolved, amplified, cryptate emission assay.

Results

Both PF-PCT and S-PCT levels were significantly higher in the PPPE group than the non-PPPE group (p = 0.01 and 0.0003, respectively). S-PCT had a better diagnostic performance than PF-PCT, with an area under the curve of the receiver operating characteristic of 0.834 for S-PCT and 0.752 for PF-PCT (p = 0.006). In the PPPE group, both PF-PCT and S-PCT levels on days 1 and 3 were significantly higher in patients who were in high-severity risk classes (all p values < 0.05). Day 3 PF-PCT/S-PCT ratios were significantly lower in patients who needed chest tube drainage for > 7.5 days (corrected p = 0.02).

Conclusion

S-PCT has higher diagnostic accuracy than PF-PCT in differentiating PPPEs from non-PPPEs. However, both PF-PCT and S-PCT are useful in the severity assessment of patients with PPPEs. The PF-PCT/S-PCT ratio may help to predict prolonged chest tube drainage.

Section snippets

Materials and Methods

The study was approved by the Ethics Committee of Chang Gung Memorial Hospital. Each patient signed an informed consent form. Patients with PF were prospectively recruited from May 2005 to September 2007 at Kaohsiung Chang Gung Memorial Hospital, a 2,000-bed university teaching hospital in southern Taiwan. Specific criteria for study inclusion were as follows: (1) age > 18 years; and (2) chest echo-guided thoracocentesis was performed by a pulmonary physician on the first day when the patient

Patient Characteristics

Figure 1 shows the study profile demonstrating the number and reasons for exclusion cases. As a result, 82 patients (61 men and 21 women) completed this study. Among these patients, 45 had PPPEs, 12 had tuberculous Pes, 7 had malignant Pes, and 18 had transudate PEs secondary to heart failure, liver cirrhosis, or end-stage renal disease. All patients were divided into a PPPE group (n = 45; 55%) and a non-PPPE group (n = 37; 45%). Table 1 compares the baseline demographic and clinical

Discussion

Several studies have shown that S-PCT is a useful marker in patients with community-acquired respiratory infections. Müller and colleagues11 showed that CAP was differentiated from other respiratory illnesses at an S-PCT cutoff level of 0.25 ng/mL, which had a sensitivity of 74% and specificity of 85%. An S-PCT level of 0.1 to 0.25 ng/mL was regarded as an indication that bacterial infection would be unlikely in two randomized trials of antibiotics guidance.12, 13 We found that PF-PCT and S-PCT

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