Li Dajiang, Shen Yongchun, Qin Jiangyue, Wan Chun, Zeng Ni, Chen Lei, Dong Yue
Center of Infectious Diseases and Department of Medical Affairs, West China Hospital/West China School of Medicine of Sichuan University, Chengdu 610041, China.
Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China.
Ann Transl Med. 2019 Jan;7(1):1. doi: 10.21037/atm.2018.11.44.
Parapneumonic pleural effusion (PPE) refers to effusion secondary to lung infection, the accurate diagnosis of which remains a clinical challenge. Many studies have suggested that the C-reactive protein (CRP) may be useful for diagnosing PPE, but the results have varied. This study aimed to summarize the overall diagnostic ability of serum/pleural CRP for PPE through a meta-analysis.
Eligible studies were searched for within PubMed, EMBASE, and other databases up to March 1, 2018. The main diagnostic indexes, sensitivity, specificity, positive likelihood ratio/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR), were then pooled from the individual studies. The summary receiver operating characteristic curves and area under the curve (AUC) were used to summarize the overall test performance.
Eighteen publications were included in this meta-analysis. Summary estimates of the diagnostic performance of pleural CRP for PPE were as follows: sensitivity, 0.80; specificity, 0.82; PLR, 4.51; NLR, 0.25; DOR, 18.26; and AUC, 0.88. The AUC of serum CRP in diagnosing PPE was 0.79. The diagnostic indexes for pleural CRP in differentiating complicated PPE (CPPE) from uncomplicated PPE were as follows: sensitivity, 0.65; specificity, 0.85; PLR, 4.26; NLR, 0.41; DOR, 10.38; and AUC, 0.83. There was no evidence of publication bias.
Both serum and pleural CRP help to diagnose PPE but with moderate diagnostic ability. Pleural CRP measurements also can aid in differentiating CPPE from uncomplicated PPE. However, the results of the CRP assay should be interpreted with additional biomarker tests.
类肺炎性胸腔积液（PPE）是指继发于肺部感染的胸腔积液，其准确诊断仍是一项临床挑战。许多研究表明，C反应蛋白（CRP）可能有助于PPE的诊断，但结果各不相同。本研究旨在通过荟萃分析总结血清/胸腔CRP对PPE的总体诊断能力。
在PubMed、EMBASE和其他数据库中检索截至2018年3月1日的符合条件的研究。然后从各个研究中汇总主要诊断指标、敏感性、特异性、阳性似然比/阴性似然比（PLR/NLR）和诊断比值比（DOR）。采用汇总的受试者工作特征曲线和曲线下面积（AUC）来总结总体检测性能。
本荟萃分析纳入了18篇文献。胸腔CRP对PPE诊断性能的汇总估计如下：敏感性为0.80；特异性为0.82；PLR为4.51；NLR为0.25；DOR为18.26；AUC为0.88。血清CRP诊断PPE的AUC为0.79。胸腔CRP区分复杂性PPE（CPPE）和非复杂性PPE的诊断指标如下：敏感性为0.65；特异性为0.85；PLR为4.26；NLR为0.41；DOR为10.38；AUC为0.83。没有证据表明存在发表偏倚。
血清和胸腔CRP均有助于PPE的诊断，但诊断能力中等。测量胸腔CRP也有助于区分CPPE和非复杂性PPE。然而，CRP检测结果应结合其他生物标志物检测进行解读。
