Respiratory Care |

The Usefulness of Serum Procalcitonin in Patients With Tuberculous Pleurisy FREE TO VIEW

Jae-Uk Song, MD; Seong Yong Lim, PhD; Si young Lim, PhD; Hye Kyeong Park, MD
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Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

Chest. 2014;146(4_MeetingAbstracts):923A. doi:10.1378/chest.1969779
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SESSION TITLE: Respiratory Infections Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Procalcitonin (PCT) is a marker of the inflammatory response to infection. Despite limited research on PCT in pulmonary tuberculosis (PTB) patients, it is known as a poor prognostic marker in PTB patients, when serum PCT is above the normal cut-off point (0.05ng/ml). However, studies for the characteristics of tuberculous pleurisy (TP) patients, according to serum PCT level, have rarely been reported. Therefore, this study evaluated the difference between TP patients with the serum PCT levels below or above the normal cut-off point, to identify the clinical implication.

METHODS: A retrospective analysis was performed in 73 patients (PCT < 0.05ng/ml, n=40 (54.8%) vs PCT ≥ 0.05ng/ml, n=33 (45.2%)) with TP diagnosis who had no isolated pathogens except for Mycobacterium tuberculosis in Kangbuk Samsung hospital, between January 2010 and December 2012

RESULTS: There were 46 male and 27 female patients with a median age of 46 years. Pleural effusion was found unilateral sided in 60 (82.2%) and both sided in 13 (17.8%) at simple radiography. Radiographic active signs of PTB were found in 38 (52.8%) among 72 patients with chest CT scan. Additionally, mycobacterial identification was possible in 4 patients (2 with culture and 2 with nucleic acid amplification test for M.tubercuosis) with inactive signs on CT scan. So, 42 patients (57.5%) belonged to the pleuro-pulmonary group. The others had isolated pleurisy. Culture for spontaneous sputum or bronchial washing specimens were performed in all the patients. Culture was positive in 27 patients (37.0%). Out of 70 patients with effusion culture result, culture was positive in 17 (24.3%). In a multiple logistic regression analysis, the patients with above the normal cut-off point (0.05ng/ml) had significantly pleuro-pulmonary lesions (OR, 64.179; 95% CI, 1.945 - 2117.439, P=0.020), and positive result in culture for pleural fluid (OR, 27.703; 95%CI, 1.392 - 551.348, P=0.030).

CONCLUSIONS: Serum PCT level above the normal cut-off point would suggest the presence of pleuro-pulmonary lesions and positive culture for pleural fluid in TP patients. So, it might aid physicians to decide whether to isolate initially, and to evaluate the effusion aggressively, for microbiological confirmation and drug sensitivity test.

CLINICAL IMPLICATIONS: Clinical implication of serum PCT above the normal, demonstrated by these findings is the potential risk of M. tuberculosis transmission to contacts and help to diagnose TP by microbiological confirmation.

DISCLOSURE: The following authors have nothing to disclose: Jae-Uk Song, Seong Yong Lim, Si young LIm, Hye Kyeong Park

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