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Diagnostic performance of C-reactive protein for parapneumonic pleural effusion: a meta-analysis
Dajiang Li1, Yongchun Shen2, Jiangyue Qin2
1Center of Infectious Diseases and Department of Medical Affairs, West China Hospital/West China School of Medicine of Sichuan University, Chengdu 610041, China.
Background:
Parapneumonic pleural effusion (PPE) refers to effusion secondary to lung infection, the accurate diagnosis of which remains a clinical challenge. Many studies have suggested that the C-reactive protein (CRP) may be useful for diagnosing PPE, but the results have varied. This study aimed to summarize the overall diagnostic ability of serum/pleural CRP for PPE through a meta-analysis.
Methods:
Eligible studies were searched for within PubMed, EMBASE, and other databases up to March 1, 2018. The main diagnostic indexes, sensitivity, specificity, positive likelihood ratio/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR), were then pooled from the individual studies. The summary receiver operating characteristic curves and area under the curve (AUC) were used to summarize the overall test performance.
Results:
Eighteen publications were included in this meta-analysis. Summary estimates of the diagnostic performance of pleural CRP for PPE were as follows: sensitivity, 0.80; specificity, 0.82; PLR, 4.51; NLR, 0.25; DOR, 18.26; and AUC, 0.88. The AUC of serum CRP in diagnosing PPE was 0.79. The diagnostic indexes for pleural CRP in differentiating complicated PPE (CPPE) from uncomplicated PPE were as follows: sensitivity, 0.65; specificity, 0.85; PLR, 4.26; NLR, 0.41; DOR, 10.38; and AUC, 0.83. There was no evidence of publication bias.
Conclusions:
Both serum and pleural CRP help to diagnose PPE but with moderate diagnostic ability. Pleural CRP measurements also can aid in differentiating CPPE from uncomplicated PPE. However, the results of the CRP assay should be interpreted with additional biomarker tests.
Insights
C-reactive protein (CRP) aids in diagnosing parapneumonic pleural effusion (PPE) with moderate accuracy. Pleural CRP also helps distinguish complicated from uncomplicated PPE, but should be used with other biomarkers.
Area of Science:
- Pulmonology
- Clinical Diagnostics
- Biomarker Research
Background:
- Parapneumonic pleural effusion (PPE) diagnosis is challenging.
- C-reactive protein (CRP) shows potential but variable utility in PPE diagnosis.
- Meta-analysis needed to clarify CRP's diagnostic role.
Purpose of the Study:
- To evaluate the overall diagnostic ability of serum and pleural CRP for PPE.
- To assess CRP's effectiveness in differentiating complicated PPE (CPPE) from uncomplicated PPE.
Main Methods:
- Systematic literature search of PubMed, EMBASE up to March 2018.
- Meta-analysis of diagnostic indexes: sensitivity, specificity, PLR, NLR, DOR, AUC.
- Summary receiver operating characteristic (sROC) curves used for performance assessment.
Main Results:
- Pleural CRP demonstrated good diagnostic performance (AUC=0.88) for PPE.
- Serum CRP showed moderate diagnostic ability (AUC=0.79) for PPE.
- Pleural CRP also aided in differentiating CPPE (AUC=0.83).
Conclusions:
- Serum and pleural CRP offer moderate diagnostic capabilities for PPE.
- Pleural CRP can assist in distinguishing complicated from uncomplicated PPE.
- CRP results require interpretation alongside other biomarker tests for definitive diagnosis.
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