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A4221 - Diagnostic Value of Presepsin, C-Reactive Protein, and Procalcitonin in Pleural Effusion
Author Block: N. Watanabe1, T. Ishii1, N. Kita1, N. Kanaji1, H. Nakamura2, N. Nanki3, Y. Ueda4, Y. Tojo5, N. Kadowaki1, S. Bandoh1; 1Department of Internal Medicine, Hematology, Rheumatology and Respiratory Medicine, Kagawa University, Kita-gun, Japan, 2Department of Respiratory medicine, Sakaide City Hospital, Sakaide-City, Japan, 3Department of Respiratory medicine, Sanuki municipal hospital, Sanuki-shi, Japan, 4Department of Respiratory medicine, Kagawa Prefectural Central hospital, Takamatsu, Japan, 5Department of Respiratory medicine, National hospital organization Takamatsu medical center, Takamatsu, Japan.
Rationale: Complications can arise when the diagnosis and initiation of proper therapy for infectious pleural effusions are delayed, which can happen in the absence of robust diagnostic criteria. Although presepsin has been shown to be a specific and sensitive marker for the diagnosis of sepsis, little has been reported to date on the diagnostic value of presepsin levels in body fluids. The aims of this study were to evaluate the pleural fluid concentrations of presepsin in patients with different causes of pleural effusions, and to compare the usefulness with pleural fluid C-reactive protein (CRP) an procalcitonin (PCT). Methods: We analized 132 patients with pleural effusion who underwent diagnostic evaluation and classified them into six categories: empyema, parapneumonic effusion, tuberculous effusion, malignant effusion, paramalignant effusion, and transudate effusion. In addition, all pleural effusions were divided into infectious or non-infectious effusions. Results: The numbers of patients for each group were: empyema, 11; parapneumonic effusion, 16; tuberculous effusion, 9; malignant effusion, 46; paramalignant effusion, 13; transudate effusion, 10; unclassified, 27. There were 38 patients classified as infectious effusions and 94 patients classified as non-infectious effusions. Receiver operating characteristic analysis was used to evaluate diagnostic performance. When diagnosing empyema, the highest sensitivity was pleural fluid presepsin (cut-off 754 pg/mL; sensitivity 90.9%) and the highest specificity was pleural fluid CRP (cut-off 4.91 mg/dL; specificity 89.3%). Likewise, when diagnosing infectious pleural effusion, the highest sensitivity was pleural fluid presepsin (cut-off 680 pg/mL; sensitivity 68.4%) and the highest specificity was pleural fluid CRP (cut-off 2.59 mg/dL; specificity 90.4%). Conclusions: Pleural fluid presepsin levels may be useful as an additional tool in the assessment of pleural effusions to support the differential diagnosis between infectious and non-infectious etiologies. Low pleural fluid presepsin levels are not likely to indicate empyema or infectious pleural effusion, while high pleural fluid CRP levels may represent empyema and infectious pleural effusion. However, procalcitonin is of lesser value for the differential diagnosis of pleural effusions.