Pulmonary Department, 401 General Military Hospital of Athens, Athens, Greece.
Respirology. 2012 Feb;17(2):308-14. doi: 10.1111/j.1440-1843.2011.02078.x.
Parapneumonic effusions (PPE) that require drainage are referred to as complicated parapneumonic effusions (CPPE). Following resolution of these effusions, residual pleural thickening (RPT) may persist. We hypothesize that the concentrations of CRP in pleural fluid (CRP(pf)) and serum (CRP(ser)) can be used to identify CPPE and to predict RPT.
All patients with non-purulent PPE, who were admitted to two tertiary hospitals during a 30-month period, were enrolled in the study. Baseline CRP(pf) and CRP(ser) levels were compared between patients with complicated or uncomplicated PPE, as well as between patients with or without RPT of >10 mm, 6 months after discharge from hospital. Cut-off values for identification of CPPE and prediction of RPT were determined by receiver operating characteristic curve analysis. Logistic regression analysis was performed to assess the association between CRP levels and RPT.
Fifty-four patients were included in the study. Patients with CPPE (n = 23) had significantly higher levels of both CRP(pf) and CRP(ser) than those with uncomplicated PPE. For identification of CPPE, a CRP(pf) level >78.5 mg/L and a CRP(ser) level >83 mg/L gave 84% and 47% sensitivity, with 65% and 87% specificity, respectively. Classical criteria (pleural fluid pH <7.20, LDH >1000 IU/L, glucose <600 mg/L) were superior for this purpose. A combination of classical biomarkers with CRP levels using an 'AND' or 'OR' rule improved the positive and negative predictive values, respectively. CRP(ser) was an independent predictor for development of RPT (adjusted OR 1.18). A CRP(ser) level >150 mg/L had 91% specificity and 61% sensitivity for prediction of RPT.
This study demonstrated the value of CRP(ser) for prediction of RPT in patients with PPE. Moreover, when used in combination with classical biomarkers, CRP levels may be a useful adjunct for decision-making in relation to treatment of patients with non-purulent PPE.
需要引流的类肺炎性胸腔积液（PPE）被称为复杂性类肺炎性胸腔积液（CPPE）。这些胸腔积液消退后，可能仍会残留胸腔增厚（RPT）。我们假设胸腔液（CRP(pf)）和血清（CRP(ser)）中的 CRP 浓度可用于识别 CPPE 并预测 RPT。
在 30 个月期间，我们招募了两所三级医院收治的所有非脓性 PPE 患者。比较了复杂性或非复杂性 PPE 患者以及出院后 6 个月 RPT >10mm 的患者的 CRP(pf)和 CRP(ser)基线水平。通过受试者工作特征曲线分析确定 CPPE 识别和 RPT 预测的截断值。采用逻辑回归分析评估 CRP 水平与 RPT 之间的关系。
本研究共纳入 54 例患者。CPPE 患者（n=23）的 CRP(pf)和 CRP(ser)水平明显高于非复杂性 PPE 患者。对于 CPPE 的识别，CRP(pf)水平>78.5mg/L 和 CRP(ser)水平>83mg/L 的敏感性分别为 84%和 47%，特异性分别为 65%和 87%。经典标准（胸腔液 pH<7.20、LDH>1000IU/L、葡萄糖<600mg/L）在这方面更具优势。使用“与”或“或”规则将经典生物标志物与 CRP 水平相结合可分别提高阳性和阴性预测值。CRP(ser)是 RPT 发生的独立预测因子（调整后的 OR 1.18）。CRP(ser)水平>150mg/L 对 RPT 的预测具有 91%的特异性和 61%的敏感性。
本研究表明 CRP(ser)对预测 PPE 患者的 RPT 有价值。此外，当与经典生物标志物联合使用时，CRP 水平可能是决策非脓性 PPE 患者治疗的有用辅助手段。
