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

Chest & Heart JournalVol. 35, No. 2, July 2011ORIGINAL ARTICLEAssessment of Diagnostic Value of C-ReactiveProtein in Granulomatous PleuritisSaroj Kanti Chowdhury 1 , Taposh Bose 1 , Md. Khairul Anam 2 , Nihar Ranjan Saha 2 ,Md. Sirajul Islam 3 , Bipul Kanti Biswas 3 , Mohammed Shahedur Rahaman Khan 4 ,Biswas Akhtar Hossain 4 , K.C Ganguly 4 , S.M.Abdur Razzaque 4 , AKM Mustafa Hussain 5 ,Mirza Mohammad Hiron 6Abstract:Background: Tuberculosis is an ancient human disease. The determination ofbiological marker levels in pleural effusions has been proposed as an alternativenoninvasive means of establishing a diagnosis of granulomatous pleuritis . Avariety of biological markers have been proposed to facilitate differential diagnosisof granulomatous pleuritis, C-reactive protein (CRP) is one of them. The presentstudy was conducted to find out the sensitivity, specificity, accuracy, positiveand negative predictive value of CRP for diagnosis of granulomatous pleuritis.Method: The study was a cross sectional study conducted for one year fromJanuary 2010 to December 2010 in the Department of Respiratory Medicine,National Institute of Diseases of the Chest and Hospital, Mohakhali, Dhaka.Total 103 patients with clinically and radiologically diagnosed pleural effusionwere included in the study. All patients of 18-80 years of age and both sexes withpleural effusion who were admitted during the study period in NIDCH andsubsequently undergone thoracentesis were included in the present study throughpurposive sampling following inclusion and exclusion criteria.Result: In the present study mean ± SD of age of the patient was 50.24 ± 18.38years. Out of 103 cases of pleural effusion cases 50 (48.5%) were granulomatouspleuritis 8 them 46 were CRP +ve & 4 were CRP -ve and another 50 (48.5%) caseswere caused by malignancy. Rheumatoid arthritis, nephrotic syndrome andcongestive cardiac failure were found as the causes of pleural effusion one in each(1.0%) at cut of value 8.48. Sensitivity, specificity, PPV, NPV and accuracy of C -reactive protein in the diagnosis of granulomatous pleuritis were 92.0%, 90.6%,90.2%, 92.3% and 91.3% respectively. Positive Likelihood Ratio was 9.752 andNegative Likelihood Ratio was 0.088.Conclusion: The result indicated that the analysis of C - reactive protein levels inpleural fluid constitute a very useful marker for the diagnosis of granulomatous pleuritiswhich, in addition, can be made quickly and cheaply. So, we may conclude that overallthis test is a very helpful adjunct test for the diagnosis of granulomatous pleuritis.[Chest & Heart Journal 2011; 35(2) : 77-85]1. Emergency Medical Officer, National Institute of Diseases of the Chest and Hospital, Mohakhali, Dhaka.2. Registrar (Respiratory Medicine), National Institute of Diseases of the Chest and Hospital, Mohakhali, Dhaka.3. RMO, NIDCH4. Assistant Professor (Respiratory Medicine), National Institute of Diseases of the Chest and Hospital,Mohakhali, Dhaka.5. Associate Professor (Respiratory Medicine) & Director, National Institute of Diseases of the Chest and Hospital,Mohakhali, Dhaka.6. Professor (Respiratory Medicine) & Former Director, National Institute of Diseases of the Chest and Hospital,Mohakhali, Dhaka.Correspondence to: Emergency Medical Officer, National Institute of Diseases of the Chest and Hospital,Mohakhali, Dhaka, Email – sarojcdr@yahoo.com