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

Khosla, Rahul; Khosla, Shikha; Becker, Kenneth L.; Nylen, Eric

doi:10.1002/jhm.2551

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…Escalation of PCT is now regarded as a useful serological biomarker of bacterial infection (8). In recent years, some multi-center clinical studies have explored the diagnostic effectiveness of PCT in serum or PE, but have drawn conflicting conclusions, leading to a controversial status for the diagnostic role of pleural PCT (9,10).…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

et al. 2021

Ann Transl Med

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Background: Exudative 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.Methods: This 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. Results:The 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. Conclusions:The 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.

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Section: Introductionmentioning

confidence: 99%

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

Zhang

et al. 2021

Ann Transl Med

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“…Furthermore, Khosla, et al investigated the diagnostic value of PCT in distinguishing infectious and noninfectious etiologies of pleural effusion, and the analysis results showed that PCT is a novel biomarker for diagnosing infectious pleural effusion [14]. Facing with these contradictory outcomes, here we examined the relationship between p-PCT and s-PCT levels in EPE from different groups and explored the various causes of pleural effusions.…”

Section: Discussionmentioning

confidence: 94%

Combined Analysis of C-reactive Protein in Pleural Fluid and Serum is Effective in the Differential Diagnosis of Exudative Pleural Effusions

Zhang

et al. 2021

Preprint

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Background: Exudative 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, providing effective treatments. Thoracoscopy is a useful tool for differential diagnosis of EPE. However, some patients would refuse thoracoscopic examination due to its invasive nature. In addition, the specificity and sensitivity of existing routine tests of EPE are less satisfying. Therefore, there is a great need to establish an effective method for differential diagnosis of EPE.Methods: This study was a single-institution retrospective analysis of diagnostic efficiency of C-reactive protein (CRP) and procalcitonin (PCT) between March 2018 and September 2018. Eighty-seven patients diagnosed with EPE were enrolled. All patients underwent diagnostic thoracentesis. And the EPE was examined using biochemical, routine, microbiological, and cytological methods. Pathological cytology detection was of necessity for those with the suspicion of malignant PE. Benign PE comes from patients with pneumonia, empyema and tuberculosis. The levels of CRP and PCT of EPE and serum were measured before the treatment. Correlation analysis and receiver-operating characteristic (ROC) curve analysis were conducted to determine the underlying relationship between levels of CRP and PCT, and differential diagnosis.Results: Receiver operating characteristic analysis showed that the sensitivity and specificity for the analysis of pleural fluid CRP (p-CRP) are 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) didn’t 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.Conclusions: The 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 to diagnose bacterial infections, neither s-PCT nor p-PCT, showed correlations with the differential diagnosis of EPE.

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“…LDH is an acute reactant associated with the degree of inflammation in infectious pleural effusions; however, it is also elevated in malignant pleural effusions as LDH also acts as an intracellular enzyme that indicates the degree of cell turnover within the pleural space 1 . In addition, several studies have explored the potential utility of other new biomarkers of infection (e.g., C-reactive protein 17 , procalcitonin 18 , 19 , presepsin 20 , cell-free DNA 21 , Interleukin-27 22 ) to diagnose infectious pleural effusion. A prior study reported 75 patients with significantly elevated pleural fluid procalcitonin in IPEs (empyemas and PPEs) and pleural fluid procalcitonin > 0.25 ng/ml had a sensitivity of 77.78% and specificity of 74.14% for the diagnosis of IPEs 19 .…”

Section: Discussionmentioning

confidence: 99%

Nicotinamide phosphoribosyltransferase as a biomarker for the diagnosis of infectious pleural effusions

Huang

Guo

Kang

et al. 2021

Sci Rep

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Nicotinamide phosphoribosyltransferase (NAMPT) has been reported to be involved in infectious diseases, but it is unknown whether it plays a role in infectious pleural effusions (IPEs). We observed the levels of NAMPT in pleural effusions of different etiologies and investigated the clinical value of NAMPT in the differential diagnosis of infectious pleural effusions. A total of 111 patients with pleural effusion were enrolled in the study, including 25 parapneumonic effusions (PPEs) (17 uncomplicated PPEs, 3 complicated PPEs, and 5 empyemas), 30 tuberculous pleural effusions (TPEs), 36 malignant pleural effusions (MPEs), and 20 transudative effusions. Pleural fluid NAMPT levels were highest in the patients with empyemas [575.4 (457.7, 649.3) ng/ml], followed by those with complicated PPEs [113.5 (103.5, 155.29) ng/ml], uncomplicated PPEs [24.9 (20.2, 46.7) ng/ml] and TPEs [88 (19.4, 182.6) ng/ml], and lower in patients with MPEs [11.5 (6.5, 18.4) ng/ml] and transudative effusions [4.3 (2.6, 5.1) ng/ml]. Pleural fluid NAMPT levels were significantly higher in PPEs (P < 0.001) or TPEs (P < 0.001) than in MPEs. Moreover, Pleural fluid NAMPT levels were positively correlated with the neutrophil percentage and lactate dehydrogenase (LDH) levels and inversely correlated with glucose levels in both PPEs and TPEs, indicating that NAMPT was implicated in the neutrophil-associated inflammatory response in infectious pleural effusion. Further, multivariate logistic regression analysis showed pleural fluid NAMPT was a significant predictor distinguishing PPEs from MPEs [odds ratio (OR) 1.180, 95% confidence interval (CI) 1.052–1.324, P = 0.005]. Receiver-operating characteristic (ROC) analysis demonstrated that NAMPT was a promising diagnostic factor for the diagnosis of infectious effusions, with the areas under the curve for pleural fluid NAMPT distinguishing PPEs from MPEs, TPEs from MPEs, and IPEs (PPEs and TPEs) from NIPEs were 0.92, 0.85, and 0.88, respectively. In conclusion, pleural fluid NAMPT could be used as a biomarker for the diagnosis of infectious pleural effusions.

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

Cited by 9 publications

References 15 publications

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

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

Combined Analysis of C-reactive Protein in Pleural Fluid and Serum is Effective in the Differential Diagnosis of Exudative Pleural Effusions

Nicotinamide phosphoribosyltransferase as a biomarker for the diagnosis of infectious pleural effusions

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