Value of C-reactive protein in diagnosis of pleural effusion
Nora Ali Hussien El Kholy;
Abstract
Pleural effusion is a common problem in clinical practice. It can be caused by several mechanisms including permeability of pleural membrane , increased pulmonary hydrostatic pressure , decreased negative intrapleural pressure, decrease oncotic pressure and obstruction of lymphatic flow.
Pleural effusion may represent a primary manifestation of many diseases , but most often they are observed as a secondary manifestation or complication of other diseases.
CRP is an acute phase protein predominantly produced and
secreted by hepatocytes. Other cells including lymphocytes,
kupffer‟s cells, monocytes and macrophages can also produce
CRP.
The induction of CRP synthesis is triggered by a number of
cytokines, chiefly IL-6, which is released from a variety of cell
types, but mainly from macrophages and monocytes at
inflammatory sites.
The aim of present study was to determine the validity of
pleural fluid CRP concentration , CRP serum level and ratio of
pleural fluid to serum( CRP) in diagnosis of pleural effusion .
This prospective study was conducted upon hundred patients
with pleural effusion who were admitted to Abbasia Chest
Hospital in the period between March 3, 2012 to March 3, 2013.
168
Summary & Conclusion
All patients were subjected to :
1. Full history taking.
2. Clinical examination.
3. Radiological investigations (chest x-ray and ultrasound).
4. Laboratory investigations (Complete Blood Picture, kidney
function, liver function, random blood sugar and ESR).
5. Pleural fluid examination for:
- Chemical, bacteriological, and histopathological examinations.
7. Determination of CRP level in pleural fluid and serum for all
the patients.
The results were tabulated and statistically analyzed . It was found that:
• Fluid CRP was of highly significant difference between
transudative and exudative effusion with higher in exudates
than in transudates.
• Serum CRP was of highly significant difference between
transudative and exudative effusion with higher values in
exudates than in transudates.
• Fluid CRP was significantly different between subtypes of
exudates and the mean value in tuberculous effusion was
about twice that in malignant effusion as the mean value in
tuberculous effusion is 36.5 in malignant 20 and
parapneumonic is 13.6.
169
Summary & Conclusion
• There was significant correlation between fluid CRP and
fluid (protein and LDH )
• At cut-off value 8 mg/L. The pleural fluid CRP was more
sensitive in diagnosis of exudative effusion (93.1%), Also
its specificity in exudative effusion (100%).
Conclusion:
From the present study it was concluded that :-
• CRP could be a useful diagnostic marker for
differentiation between exudative and transudative pleural
effusion.
• CRP level in pleural fluid samples is more accurate than
it‟s level in the serum for differentiation.
• Finally, there was a high level of pleural fluid CRP in
exudative than transudative pleural effusion.
Pleural effusion may represent a primary manifestation of many diseases , but most often they are observed as a secondary manifestation or complication of other diseases.
CRP is an acute phase protein predominantly produced and
secreted by hepatocytes. Other cells including lymphocytes,
kupffer‟s cells, monocytes and macrophages can also produce
CRP.
The induction of CRP synthesis is triggered by a number of
cytokines, chiefly IL-6, which is released from a variety of cell
types, but mainly from macrophages and monocytes at
inflammatory sites.
The aim of present study was to determine the validity of
pleural fluid CRP concentration , CRP serum level and ratio of
pleural fluid to serum( CRP) in diagnosis of pleural effusion .
This prospective study was conducted upon hundred patients
with pleural effusion who were admitted to Abbasia Chest
Hospital in the period between March 3, 2012 to March 3, 2013.
168
Summary & Conclusion
All patients were subjected to :
1. Full history taking.
2. Clinical examination.
3. Radiological investigations (chest x-ray and ultrasound).
4. Laboratory investigations (Complete Blood Picture, kidney
function, liver function, random blood sugar and ESR).
5. Pleural fluid examination for:
- Chemical, bacteriological, and histopathological examinations.
7. Determination of CRP level in pleural fluid and serum for all
the patients.
The results were tabulated and statistically analyzed . It was found that:
• Fluid CRP was of highly significant difference between
transudative and exudative effusion with higher in exudates
than in transudates.
• Serum CRP was of highly significant difference between
transudative and exudative effusion with higher values in
exudates than in transudates.
• Fluid CRP was significantly different between subtypes of
exudates and the mean value in tuberculous effusion was
about twice that in malignant effusion as the mean value in
tuberculous effusion is 36.5 in malignant 20 and
parapneumonic is 13.6.
169
Summary & Conclusion
• There was significant correlation between fluid CRP and
fluid (protein and LDH )
• At cut-off value 8 mg/L. The pleural fluid CRP was more
sensitive in diagnosis of exudative effusion (93.1%), Also
its specificity in exudative effusion (100%).
Conclusion:
From the present study it was concluded that :-
• CRP could be a useful diagnostic marker for
differentiation between exudative and transudative pleural
effusion.
• CRP level in pleural fluid samples is more accurate than
it‟s level in the serum for differentiation.
• Finally, there was a high level of pleural fluid CRP in
exudative than transudative pleural effusion.
Other data
| Title | Value of C-reactive protein in diagnosis of pleural effusion | Authors | Nora Ali Hussien El Kholy | Issue Date | 2014 |
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