Discrimination of exudative pleural effusions based on multiple biological parameters

Daniil, Zoe; Ζιντζαράς, Ηλίας; Kiropoulos, Theodoros; Papaioannou, Andriana Ι.; Koutsokera, Angela; Kastanis, A.; Gourgoulianis, K.

doi:10.1183/09031936.00126306

Cited by 81 publications

(83 citation statements)

References 33 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

European Respiratory Journal

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

European Respiratory Journal

103

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“…They concluded the combination of ADA and CRP levels might be sufficient in discriminating the three different groups of pleural effusion, tubercular, malignant and PPE. 21 In the present study, in most cases of tuberculous pleural effusion the ADA levels were >40U/L and CRP levels >2mg/dl, in PPE the ADA levels were <40 U/L (except empyema cases) and CRP levels >6mg/dl, where as in both malignant and transudative pleural effusions the ADA levels were <40U/L (except a mesothelioma case) and CRP levels <2mg/dl. The present study is in accordance with findings of Daniil ZD et al 21 CONCLUSION: Both pleural fluid ADA and CRP testing are minimally invasive, inexpensive and efficacious method of differentiating pleural effusion.…”

Section: Discussionsupporting

confidence: 47%

Efficacy of Pleural Fluid Adenosine Deaminase and C-Reactive Protein Levels in Early Differential Diagnosis of Pleural Effusion.

Nusrath¹,

M²,

Rajeshwari³

et al. 2013

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-CONTEXT: Pleural effusion occurs secondary to various diseases. Common causes of exudative effusion are tuberculosis, bacterial pneumonia, and malignancy. Transudative effusion is due to systemic diseases like cardiac failure, cirrhosis of liver. Conventional methods of diagnosis may not be able to establish the cause of pleural effusion. Early diagnosis and management reduces the morbidity and mortality.AIM: The objective of the study is to estimate pleural fluid Adenosine Deaminase (ADA) and C -reactive protein (CRP) levels and to evaluate their efficacy in differential diagnosis of transudative and exudative, tuberculous and non tuberculous and inflammatory and non inflammatory effusions. MATERIAL AND METHODS: Fifty two patients of pleural effusion were investigated and divided into four groups based on diagnosis. Group I, II, III and IV had 24 cases of tuberculous effusion, 13 cases of transudative effusion, 08 cases of malignant effusion and 07 cases of parapneumonic effusion respectively. Pleural fluid was analyzed for ADA (Guisti and Galanti's method) and CRP (turbidometric immunoassay).STATISTICAL ANALYSIS: The statistical analysis was done using unpaired student't' test and p value < 0.05 was considered statistically significant. RESULTS: In the present study pleural fluid ADA revealed highly significant increase in tuberculous effusion than non tuberculous effusions (p <0.001) and also when compared with non tuberculous subgroups, transudative effusion (p < 0.001), malignant effusion (p<0.001), and PPE (p<0.01). ADA levels at a cutoff value of 40U/L, showed sensitivity, specificity, positive predictive value and negative predictive value of 91.67%, 89.3%, 88% & 92.6% respectively in tuberculous effusion. Pleural fluid CRP levels in parapneumonic effusion were significantly higher compared to other types of effusions (p<0.001). Significantly higher levels of CRP were seen in exudative effusion compared to transudative effusion (p<0.001) and in inflammatory effusion compared to non inflammatory effusion (p<0.001). ORIGINAL ARTICLEJournal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 22/ June 3, 2013Page 3988 CONCLUSIONS: Pleural fluid ADA is sensitive test in discriminating tuberculous and non tuberculous effusions. Pleural fluid CRP levels distinguish transudative from exudative effusion, inflammatory from non inflammatory effusion. ADA and CRP assays are rapid, minimally invasive and cost effective and measurement of these two parameters increases the efficacy of diagnosing pleural effusion. KEY WORDS: Adenosine deaminase, C -reactive protein, Pleural effusion. INTRODUCTION:Pleural effusion (PE) is a common complication associated with number of diseases. Accumulation of pleural fluid may be due to various causes such as increased pleural membrane permeability, increased capillary pressure, decreased oncotic pressure and lymphatic obstruction. 1 Transudative pleural effusions occur when systemic factors which effect the formation and absorption of pleural fluid are altered. Ex...

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“…However, few studies, being retrospective and small, have directly compared the accuracy of both imaging techniques in this setting. 2,3 Results indicate that either CT does not provide additional useful information beyond what has already been seen on TUS, 2 or the latter outperforms the former in the identification of complicated PPE (CPPE) defined by pleural fluid analysis (respective likelihood ratio positive of 6.92 and 2.20).…”

Section: From the Authormentioning

confidence: 96%

“…In addition, a combined usage of thoracic ultrasound (TUS) HI and a simple biomarker such as adenosine deaminase or C-reactive protein may facilitate an early classification of PPEs. 3 Despite the fact that chest CT offers a variety of useful information regarding pleural pathology that might contribute to the differentiation among PPEs, concerns regarding the cost and ionizing radiation are important considerations in daily clinical practice. Though CT is preferred for the detection of loculations, septations may only be implied.…”

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confidence: 99%