Investigation of Diagnostic Values of hsCRP in Pleural Fluid for Differentiation Tuberculosis and Malignant Pleural Effusion Pulmonary& TB Research Center

Document Type : Research Paper


1 Associate professor of biochemistry, Mashhad University of Medical Sciences, Mashhad, Iran

2 Assistant professor of pulmonology, Mashhad University of Medical Sciences, Mashhad, Iran

3 Resident of Internal Medicine,Mashhad University of Medical Sciences, Mashhad, Iran


Pleural effusion is one of the most common and important complications in pulmonology. When the absorption of pleural fluid is less than its secretion, effusion happens and diagnosis between TB and malignant pleural fluid is important. C reactive protein with high sensivity(hsCRP) is secreted by tissue when inflammations is present. The aim of this study was hsCRP[S1] evaluation could help to[S2] differentiate between TB and malignant pleural effusion
Materials and Methods
100 patients with TB or Malignant pleural effusion who referred to Emam Reza hospital, Mashhad in 2009 underwent thoracocentesis; then hsCRP with photometry methods were analyzed[S3]. All data were analyzed by SPSS 11 and cutoff point for hsCRP with ROC curve was found.
Mean age was 53.41 years 19.63 SD. Mean concentration of hsCRP was 9.53 (mg/lit) with SD 5.78 (mg/lit). hsCRP concentration in TB group was13.6±5.6 and in malignant pleural effusion group was 6.00±3.93 (mg/lit). They had[S4]significant different with statistical analysis (P<0.001). Sensitivty of hsCRP to differentiate between TB and malignancy with cutoff point of 8.35(mg/lit) is 92% and specificity is 78%. They had significant different with statistical analysis [S5](P<0.001).
hsCRP cloud help us to differentiate between TB and malignant pleural effusion.


1- Light RW. Clinical manifestations and useful tests. In: Light RW.editor. Pleural diseases. 3rd ed, Baltimore:
Williams and Wilkins;1995.p.36-74.
2- Rezaeetalab F, Ghasemie J, Akbari H, Ahmadihoseini H. Serum and Pleural fluid lbumin Gradient in differentiation
of Exudative and transudative causes. JMUMS 2007:343-350.
3- Bartter T, Santarelli R, Akers SM, Pratter MR. The evaluation of pleural effusion. Chest 1994; 106:1209-1214.
4- Escudero BC, Garcia CM, Cuesta CB. Cytologic and bacteriologic analysis of fluid and pleural specimenswith
Cope’s needle. Arch Int Med 1990; 150:1190-1194.
5- Valdes L, Alvarez D, San Jose E, Juanatey JR, Pose A, Valle JM, et al. Value of adenosine deaminase in the
diagnosis of tuberculous pleural effusions in young patients in a region of high prevalence of tuberculosis. Thorax 1995;
6- Chierakul N, Kanitsap A, Chaiprasert A, Viriyataveekul R.A simple Creactive protein measurement for
differentiation between tuberculosis and malignant pleural effusion. Respirology 2004; 9:66-69.
7- Determann RM, Achouiti AA, Elsolh AA, Bresser P, Vijifhuizen J, Spronk PE, et al. Infectious pleural effusion can
be identified by sTREM-1 levels. Respir Med 2010; 104:310-315.
8- Liu CL, Hsieh WY, Wu CL, Kuo HT. Triggering expressed on myeloid cells-1 in pleural effusion: a marker of
inflammatory disease. Respir Med 2007; 101:903-909.
9- Kiropoulos TS, Kostikas K, Oikonomidi S, Tsilioni I, Nikoulis D, Germenis A, et al. Acute phase markers for the
differentiation of infectious and malignant pleural effusions. Respir Med 2007; 101:910-918.
10- Garcia-Pachon E, Soler MJ, Padilla-Navas I, Romero V, Shum C. C-reactive protein in lymphocytic pleural
effusions: a diagnostic aid in tuberculous pleuritis. Respiration 2005; 72:486-489.
11- Calikoglu M, Sezer C, Unlu A, Kanik A, Tamer L. Use of acute phase proteins in pleural effusion discrimination.
Tuberk Toraks 2004; 52:122-129.
12- Yildirim Z, Turkoz Y, Biber C, Erdogan Y, Keyf AI. Use of pleural fluid C-reactive protein in diagnosis of pleural
effusions. Respir Med 2000; 94:432-435