• Clinical biochemistry · Oct 2013

    Procalcitonin as a diagnostic marker in differentiating parapneumonic effusion from tuberculous pleurisy or malignant effusion.

    • Seung Hyeun Lee, Eun Joo Lee, Kyung Hoon Min, Gyu Young Hur, Sung Yong Lee, Je Hyeong Kim, Chol Shin, Jae Jeong Shim, Kwang Ho In, Kyung Ho Kang, and Sang Yeub Lee.
    • Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
    • Clin. Biochem. 2013 Oct 1;46(15):1484-8.

    ObjectivesDifferential diagnosis of exudative pleural effusions can be difficult, despite the use of several biomarkers. Serum procalcitonin (s-PCT) is a well-known biomarker for systemic bacterial infections. However, the usefulness of pleural fluid procalcitonin (pf-PCT) in clinical practice has not been established. This study evaluated the usefulness of PCT measurements in differentiating parapneumonic effusion (PPE) from tuberculous (TB) pleurisy or malignant effusion.Design And MethodsNinety eight adult patients diagnosed with exudative pleural effusion were enrolled and allocated into the PPE group (n=32), TB pleurisy group (n=40), or malignant effusion group (n=26). Both s-PCT and pf-PCT concentrations were measured at admission using an immunoluminometric assay.ResultsBoth s-PCT and pf-PCT were significantly increased in the PPE group compared with the TB pleurisy or malignant effusion groups (p<0.001). The optimal cut-off value for s-PCT in the diagnosis of PPE was 0.18 ng/mL (sensitivity 83.3%, specificity 81.0%). The pf-PCT cut-off value was 0.16 ng/mL (sensitivity 81.5%, specificity 72.1%). Serum PCT exhibited better diagnostic accuracy than pf-PCT, with areas under the receiver operating characteristic curves of 0.842 for s-PCT and 0.784 for pf-PCT (p=0.015). In addition, s-PCT and pf-PCT showed better diagnostic accuracy than serum C-reactive protein (p=0.005 and p=0.023, respectively).ConclusionsMeasurement of s-PCT and pf-PCT is useful in differentiating PPE from TB pleurisy and malignant effusion. Both s-PCT and pf-PCT may be useful biomarkers in the differential diagnosis of exudative pleural effusions.Copyright © 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

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