An Evaluation of Levels of C - reactive protein in Serum and Pleural Fluid of Pleural Effusion of Different Etiology

Abstract

Background: Pleural effusion is an abnormal accumulation of fluid in the pleural cavity influencing the respiratory process in causing difficulties in the normal movement of the lungs. Pleural effusion is caused by a variety of diseases, including pulmonary infections, pleural tumour metastasis and tuberculous pleurisy. Objective: To investigate the diagnostic usefulness of pleural effusion CRP levels in the differential diagnosis of infectious pleural effusion and in discriminating exudative from transudative effusions. Material and methods: This was a cross-sectional study carried out in patients admitted in medicine ward and outdoor clinics of a tertiary care hospital in north India. The study comprised of fifty two patients of pleural effusion which satisfied the inclusion criteria. The patients age> 14 years, clinical & radiological evidence of pleural effusion were included in the study. Detailed history, thorough physical examination, radiological findings, haematological and biochemical findings were evaluated. Pleural aspiration was performed on all patients. Biochemical analysis of pleural fluid were performed in all patients including C-reactive protein levels. Results: Out of the total pleural effusion cases, 46.1% were tubercular, 25% were transudative, 15.4% were malignant and 13.5% were parapneumonic. Left site of pleural effusion was in 85.7% of parapneumonic and 75% of Tubercular. The one way analysis of variance revealed that there was significant (p<0.01) difference in the level of C-reactive protein among different types of pleural effusions. The post-hoc analysis showed that Creactive protein was found to be significantly (p=0.01) different among all the types of pleural effusions. Conclusion: Pleural fluid CRP levels in exudative effusion were significantly higher than transudative effusion. There was also significant increase in inflammatory effusion when compared to non-inflammatory effusion.