Prognostic value of C‐reactive protein in parapneumonic effusions

Skouras, Vasileios; Boultadakis, E.; Nikoulis, Dimitrios J.; Polychronopoulos, Vlasis; Daniil, Zoe; Kalomenidis, Ioannis; Gourgoulianis, Konstantinos

doi:10.1111/j.1440-1843.2011.02078.x

Cited by 23 publications

(20 citation statements)

References 25 publications

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“…Skouras and colleagues [23] used the biomarker CRP to evaluate its clinical utility as a predictor in parapneumonic effusions (PPE). It has been estimated that approximately 40% of CAP can be associated with a PPE, most of which are inconsequential [24].…”

Section: Predicting Complications Outcomes and Mortalitymentioning

confidence: 99%

How and when to use common biomarkers in community-acquired pneumonia

Shaddock

2016

Pneumonia

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Community-acquired pneumonia (CAP) is a leading cause of death in both the developed and developing world. The very young and elderly are especially vulnerable. Even with appropriate early antibiotics we still have not improved the outcomes in these patients since the 1950s, with 30-day case fatality rates of between 10–12%. Interventions to improve outcomes include immunomodulatory agents such as macrolides and corticosteroids. Treating doctors identify CAP patients who are likely to have poor outcomes by using severity scores such as the pneumonia severity index and CURB-65, which allows these patients to be placed in ICU settings from the start of the admission. Another novel way to identify these patients is with the use of biomarkers. This review illustrates how various biomarkers have been shown to predict mortality, complications and response to treatment in CAP patients. The evidence using either procalcitonin or C-reactive protein to demonstrate response to treatment and hence that the antibiotics chosen are appropriate can play an important role in antibiotic stewardship.

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Section: Predicting Complications Outcomes and Mortalitymentioning

confidence: 99%

How and when to use common biomarkers in community-acquired pneumonia

Shaddock

2016

Pneumonia

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“…Pleural CRP levels are reportedly higher in parapneumonic effusions than in other types of exudates [ 2 , 14 , 18 ]. Evaluation of the pleural CRP levels is a useful test for differentiating between complicated and uncomplicated parapneumonic effusions [ 9 , 17 ] and between acute and chronic inflammation [ 18 ]. Kapisyzi et al [ 14 ] observed that the sensitivity of pleural CRP levels was higher than serum CRP levels in distinguishing transudative effusions from exudative effusions as well as malignant effusions from benign effusions.…”

Section: Discussionmentioning

confidence: 99%

“…Porcel et al [ 9 ] found that CRP levels >10 mg/dL were associated with complicated parapneumonic effusion and were associated with the need for pleural effusion drainage. Moreover, the combination of classical biomarkers (pleural pH < 7.2, LDH > 100 IU/dL, and glucose < 60 mg/dL) improves the accuracy of detecting parapneumonic effusion [ 9 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

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The Diagnostic Value of the Pleural Fluid C-Reactive Protein in Parapneumonic Effusions

et al. 2016

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Purpose. The aim of this study was to evaluate the sensitivity of pleural C-reactive protein (CRP) biomarker levels in identifying parapneumonic effusions. Methods. A single-center, retrospective review of 244 patients diagnosed with pleural effusions was initiated among patients at the Rabin Medical Center, Petah Tikva, Israel, between January 2011 and December 2013. The patients were categorized into 4 groups according to their type of pleural effusion as follows: heart failure, malignant, post-lung transplantation, and parapneumonic effusion. Results. The pleural CRP levels significantly differentiated the four groups (p < 0.001) with the following means: parapneumonic effusion, 5.38 ± 4.85 mg/dL; lung transplant, 2.77 ± 2.66 mg/dL; malignancy, 1.19 ± 1.51 mg/dL; and heart failure, 0.57 ± 0.81 mg/dL. The pleural fluid CRP cut-off value for differentiating among parapneumonic effusions and the other 3 groups was 1.38 mg/dL. The sensitivity, specificity, positive predictive value, and negative predictive value were 84.2%, 71.5%, 37%, and 95%, respectively. A backward logistic regression model selected CRP as the single predictor of parapneumonic effusion (OR = 1.59, 95% CI = 1.37–1.89). Conclusions. Pleural fluid CRP levels can be used to distinguish between parapneumonic effusions and other types of exudative effusions. CRP levels < 0.64 mg/dL are likely to indicate a pleural effusion from congestive heart failure, whereas levels ≥ 1.38 mg/dL are suggestive of an infectious etiology.

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“…Approximately 40% of patients hospitalized with pneumonia have an accompanying pleural effusion [2]. Morbidity and mortality are higher in patients with pneumonia and pleural effusion than in those without pleural effusion [3].…”

Section: Introductionmentioning

confidence: 99%