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International Journal of Clinical Biochemistry and Research


USEFULNESS OF PLEURAL FLUID CRP LEVEL IN DIFFERENTIAL DIAGNOSIS OF EXUDATIVE PLEURAL EFFUSION – A PILOT STUDY


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Author Details: Sanjay D Gabhale, Pallavi Taparia, Dharamveer Yadav, S.P. Agnihotri

Volume : 2

Issue : 2

Online ISSN : 2394-6377

Print ISSN : 2394-6369

Article First Page : 97

Article End Page : 109



Abstract

Background: Pleural effusion is an abnormal collection of fluid in pleural space resulting from excess production or disruptions of homeostatic forces that regulate the flow of fluid in and out of the area. It is a frequent manifestation of serious thoracic disease whose specific diagnosis is a challenging task. Pleural effusion can be due to Infectious, malignant, parapneumonic disease and tubercular or other causes. Diagnosis of PE is not straight forward due to associated heart disease, malignancy or infection. A specific biomarker is therefore required for differential diagnosis of pleural effusion. C- Reactive Protein is an acute phase protein synthesized by hepatocytes and widely used to assess severity of infection and is directly associated to degree of inflammation in diseased state. The aim of this study is to assess specificity and sensitivity of Pleural Fluid CRP and other routine biochemical indices in diagnosis of exudative Pleural effusion arising due to varying etiologies.

Material and Method: The study involved 187 adult patients diagnosed with exudative pleural effusionand classified into 5 groups as follows: 1. malignant pleural effusion (MPE), 2. Chronic non-specific inflammation (CNI), 3. Parapneumonic pleural effusion (PPE), 4.Tubercular pleural effusion (TBPE) and 5. Others. After complete clinical evaluation, routine Pleural fluid analysis and CRP was analysed. Reciever Operating Characterstics (ROC) analysis established the cutoffs of CRP for discriminating between groups.
Result and Discussion: Pleural Fluid CRP level was significantly higher in infectious parapneumonic group, followed by Chronic non specific inflammatory group and Tubercular cases with lowest value in malignant group. ROC analysis of Pleural fluid CRP provided good sensitivity (97.05%), specificity (71.76%), NPV of 95.31% and PPV of 80.48 %for the differentiation of tubercular vs. non tubercular effusions. In ROC analysis of CRP for differentiation of Parapneumonic from non Parapneumonic pleural effusion (tubercular, chronic non-specific inflammation, malignant and others), sensitivity of 100%, specificity 98.88%, NPV of 100% and PPV of 81.82% was seen at cut off level of 90.8 mg/l. It provides largest Area under Curve I.e 1.000. CONCLUSION: Pleural fluid CRP can be used as a diagnostic aid specially differentiating between acute and chronic inflammation and also between infectious and non infectious inflammation with CRP value more than 30 mg/l almost excludes malignancy. Pleural fluid CRP can be used as specific biomarker for differential diagnosis of Parapneumonic pleural effusion with excellent sensitivity and acceptable specificity.

Keywords:
Exudative Pleural Effusion, C - reactive protein, Parapneumonic, Malignant.