Parapneumonic effusions (PPEs) that do not resolve with only antibiotics and require drainage for severe sepsis to be obviated, are called complicated (CPPEs). Once resolved, PPEs can be also complicated by pleural fibrosis. Severe sepsis and pleural fibrosis are the main short- and long-term PPEs complications, respectively. C-Reactive Protein (CRP) is an acute phase protein produced in liver under the stimulation of IL-6. CRPpf levels have been used for the differentiation of transudative from exudative and infectious from malignant pleural effusions. The aim of this study was to evaluate CRP as a prognostic marker for short- and long term complications.
We prospectively evaluated serum (CRPser) and pleural fluid (CRPpf) CRP levels in 19 consecutive patients with PPE, during a 14-month period. Patients were first divided according to the need for pleural fluid drainage and afterwards according to the presence of pleural fibrosis on CXR, six months after the diagnosis. The need for drainage was based on clinical decision. Comparisons between the groups were made with Mann-Whitney test. A p < 0.05 was considered statistically significant.
Eight patients had CPPEs while PPE in eleven patients resolved with only antibiotics. Three patients had pleural fibrosis and only two of them had a CPPE. In contrary to CRPser (p = 0.07), CRPpf was significantly different between the complicated and the uncomplicated PPEs (p = 0.01). Neither serum (p = 0.976), nor pleural fluid (p = 0.853) CRP levels could predict the induction of pleural fibrosis.
1.CRPpf, but not CRPser, could be used for the diagnosis of short-term complications of PPEs.2.Pleural fibrosis can occur regardless of the need for pleural fluid drainage3.CRP cannot predict the long-term complications of PPEs4.More patients are needed for definite conclusions to be made.
CRPpf levels can aid in the diagnosis of CPPEs but cannot predict long-term complications.
Eleni Stagaki, No Financial Disclosure Information; No Product/Research Disclosure Information