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Original Research: PLEURAL EFFUSIONS |

Diagnostic and Prognostic Values of Pleural Fluid Procalcitonin in Parapneumonic Pleural Effusions

Meng-Chih Lin, MD; Yung-Che Chen, MD; Jiun-Ting Wu, MD; Yang-Chin Ko, MD; Chin-Chou Wang, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Correspondence to: Meng-Chih Lin, MD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chang Gung Memorial Hospital, Kaohsiung, 123 Ta-Pei Rd, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan; e-mail: mengchih@adm.cgmh.org.tw


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(1):205-211. doi:10.1378/chest.08-1134
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Background:  The role of procalcitonin (PCT) in parapneumonic pleural effusion (PPPE) as a diagnostic and prognostic biomarker of the outcome has not been examined before.

Methods:  From the emergency department, 82 adult patients with pleural effusions were enrolled in this prospective study and divided into the following two groups: the PPPE group (n = 45); and the non-PPPE group (n = 37). Levels of pleural fluid (PF) PCT and serum (S) PCT were determined in all patients after study enrollment as well as on day 3 only in the PPPE group by a newly developed time-resolved, amplified, cryptate emission assay.

Results:  Both PF-PCT and S-PCT levels were significantly higher in the PPPE group than the non-PPPE group (p = 0.01 and 0.0003, respectively). S-PCT had a better diagnostic performance than PF-PCT, with an area under the curve of the receiver operating characteristic of 0.834 for S-PCT and 0.752 for PF-PCT (p = 0.006). In the PPPE group, both PF-PCT and S-PCT levels on days 1 and 3 were significantly higher in patients who were in high-severity risk classes (all p values < 0.05). Day 3 PF-PCT/S-PCT ratios were significantly lower in patients who needed chest tube drainage for > 7.5 days (corrected p = 0.02).

Conclusion:  S-PCT has higher diagnostic accuracy than PF-PCT in differentiating PPPEs from non-PPPEs. However, both PF-PCT and S-PCT are useful in the severity assessment of patients with PPPEs. The PF-PCT/S-PCT ratio may help to predict prolonged chest tube drainage.

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