Kogan Yana, Sabo Edmond, Odeh Majed
Department of Internal Medicine A, Bnai Zion Medical Center, Haifa 31048, Israel.
Pulmonary Division, Carmel Medical Center, Haifa 31048, Israel.
Diagnostics (Basel). 2020 Oct 15;10(10):829. doi: 10.3390/diagnostics10100829.
The role of serum C-reactive protein (CRPs) and pleural fluid CRP (CRPpf) in discriminating uncomplicated parapneumonic effusion (UCPPE) from complicated parapneumonic effusion (CPPE) is yet to be validated since most of the previous studies were on small cohorts and with variable results. The role of CRPs and CRPpf gradient (CRPg) and of their ratio (CRPr) in this discrimination has not been previously reported. The study aims to assess the diagnostic efficacy of CRPs, CRPpf, CRPr, and CRPg in discriminating UCPPE from CPPE in a relatively large cohort.
The study population included 146 patients with PPE, 86 with UCPPE and 60 with CPPE. Levels of CRPs and CRPpf were measured, and the CRPg and CRPr were calculated. The values are presented as mean ± SD.
Mean levels of CRPs, CRPpf, CRPg, and CRPr of the UCPPE group were 145.3 ± 67.6 mg/L, 58.5 ± 38.5 mg/L, 86.8 ± 37.3 mg/L, and 0.39 ± 0.11, respectively, and for the CPPE group were 302.2 ± 75.6 mg/L, 112 ± 65 mg/L, 188.3 ± 62.3 mg/L, and 0.36 ± 0.19, respectively. Levels of CRPs, CRPpf, and CRPg were significantly higher in the CPPE than in the UCPPE group ( < 0.0001). No significant difference was found between the two groups for levels of CRPr ( = 0.26). The best cut-off value calculated by the receiver operating characteristic (ROC) analysis for discriminating UCPPE from CPPE was for CRPs, 211.5 mg/L with area under the curve (AUC) = 94% and < 0.0001, for CRPpf, 90.5 mg/L with AUC = 76.3% and < 0.0001, and for CRPg, 142 mg/L with AUC = 91% and < 0.0001.
CRPs, CRPpf, and CRPg are strong markers for discrimination between UCPPE and CPPE, while CRPr has no role in this discrimination.
血清C反应蛋白（CRPs）和胸水C反应蛋白（CRPpf）在鉴别单纯性类肺炎性胸腔积液（UCPPE）和复杂性类肺炎性胸腔积液（CPPE）中的作用尚未得到验证，因为之前的大多数研究样本量较小且结果各异。此前尚未报道CRPs、CRPpf梯度（CRPg）及其比值（CRPr）在这种鉴别中的作用。本研究旨在评估CRPs、CRPpf、CRPr和CRPg在一个相对较大队列中鉴别UCPPE和CPPE的诊断效能。
研究人群包括146例胸腔积液患者，其中86例为UCPPE，60例为CPPE。检测CRPs和CRPpf水平，并计算CRPg和CRPr。数值以均值±标准差表示。
UCPPE组的CRPs、CRPpf、CRPg和CRPr的平均水平分别为145.3±67.6mg/L、58.5±38.5mg/L、86.8±37.3mg/L和0.39±0.11，CPPE组分别为302.2±75.6mg/L、112±65mg/L、188.3±62.3mg/L和0.36±0.19。CPPE组的CRPs、CRPpf和CRPg水平显著高于UCPPE组（<0.0001）。两组之间的CRPr水平无显著差异（=0.26）。通过受试者工作特征（ROC）分析计算出的鉴别UCPPE和CPPE的最佳截断值，CRPs为211.5mg/L，曲线下面积（AUC）=94%，<0.0001；CRPpf为90.5mg/L，AUC=76.3%，<0.0001；CRPg为142mg/L，AUC=91%，<0.0001。
CRPs、CRPpf和CRPg是鉴别UCPPE和CPPE的有力标志物，而CRPr在这种鉴别中无作用。
