Volume. 35, No. 2 july. 2011 - The Chest and Heart Association of ...

Chest & Heart Journal Vol. 35, No.-2, July 2011Table-VIIIValidity testValidity test Value (%) 95% CISensitivity 92.0 84.8-96.1Specificity 90.6 83.7-94.5PPV # 90.2 83.1-94.2NPV * 92.3 85.3-96.3Accuracy 91.3 84.2-95.3Positive Likelihood Ratio 9.752Negative Likelihood Ratio 0.088Pre-test probability 48.5%Post test probability (LR +ve) 90.5%Post test probability (LR -ve) 7.5%#PPV = Positive Predictive Value*NPV = Negative Predictive ValueTable VIII shows the validity test of C - reactiveprotein in the diagnosis of granulomatous pleuritis.Sensitivity, specificity, PPV, NPV and accuracywere 92.0%, 90.6%, 90.2%, 92.3% and 91.3%respectively. Positive Likelihood Ratio was 9.752which is much more away from 1.0 the base lineto determine the sensitivity. The likelihood ratiofor negative result was 0.088 which indicate that anegative result has less chance to have the diseasewhich intern increases the specificity. At cut offvalue (48mg/l), the pre-test probability of CRP valuefor the diagnosis of granulomatous pleuritis is48.5% but post test probability at the same cut offvalue (48 mg/l) is 90.5% which indicate that thetest is applicable for the diagnosis of granulomatouspleuritis.Table-IXDistribution of CRP with ADA results andbiopsied pleural tissue (granuloma positive)CRP ADA positive Biopsy forGranulomapositiveCRP Positive n=51 46 (69.7) 46 (92.0)CRP Negative n=52 20 (30.3) 04 (08.0)Total n=103 66 (100.0) 50 (100.0)Number within parenthesis indicate percentageTable IX shows the distribution of CRP with ADAresults and biopsied pleural tissue granulomapositive. Among the 103 patients with pleuraleffusion 51 were CRP positive and 52 CRP negative.Among the 66 patients with ADA positive 46 wereCRP positive and 20 CRP negative. Among the 50patients with granulomatous pleuritis positive 46were CRP positive and 4 CRP negative. All theCRP positive cases were positive for both ADA andgranuloma.Fig.-3: Validity testDiscussion:C-reactive protein (CRP) in pleural fluid have beenfound to be higher in tuberculosis andparapneumonic effusions than in other causes ofpleural effusion 18 . The present cross sectionalstudy was conducted between the period of January2010 to December 2010 in the Department ofRespiratory Medicine, National Institute ofDiseases of the Chest and Hospital, Mohakhali,Dhaka. The present study was conducted withthe aim to find out that the C - reactive protein isa sensitive and specific marker for the diagnosisof patients with granulomatous pleuritis. Total103 patients with clinically and radiologicallydiagnosed pleural effusion were included in thestudy.In the present study out of 103 patients withpleural effusion 74 were male and 29 were female.Male and female ratio was 1.9:1. Mean ± SD of ageof the patient was 50.24 ± 18.38 years. Among themale highest number of patients were in the agegroup of 51 to 60 years (29.1%) followed by 61 to 70years (18.9%). Other age groups were d”20 years,20-30 years, 31-40 years, 41-50 years and more than70 years were 08 (10.8%), 06 (08.1%), 09 (12.2%),08 (10.8%) and 07 (09.5%) respectively. Mean ± SDof age of male was 50.73 ± 19.27 years. Among thefemale highest number of patients were in the agegroup of 51 to 60 years (27.6%) followed by 41 to 5082