calca-protein--human and Pleural-Effusion

We aimed to perform a systematic review and meta-analysis of the diagnostic performance of pleural fluid procalcitonin (PCT) or C-reactive protein (CRP) in differentiating parapneumonic effusion in patients with pleural effusion.. We searched the EMBASE, MEDLINE, and Cochrane database in December 2011. Original studies that reported the diagnostic performance of PCT alone or compared with that of other biomarkers for differentiating the characteristics of pleural effusion were included.. We found 6 qualifying studies including 780 patients with suspected parapneumonic effusion and 306 confirmed cases of parapneumonic effusion. Six studies examined the diagnostic performance of pleural fluid PCT, 3 also tested for serum PCT, and another 3 tested for serum CRP. The bivariate pooled sensitivity and specificity were as follows 0.67 (95% confidence interval [CI], 0.54-0.78) and 0.70 (95% CI, 0.63-0.76), respectively, for pleural fluid PCT; 0.65 (95% CI, 0.55-0.74) and 0.68 (95% CI, 0.62-0.74), respectively, for serum PCT; and 0.54 (95% CI, 0.47-0.61) and 0.77 (95% CI, 0.72-0.81), respectively, for serum CRP. There was evidence of significant heterogeneity (I(2)=55.0%) for pleural fluid or serum PCT but not for CRP (I(2)=0.0%).. The existing literature suggests that both pleural fluid and serum PCT tests have low sensitivity and specificity for differentiating parapneumonic effusion from other etiologies of pleural effusion. Compared with PCT, serum CRP has higher specificity and a higher positive likelihood ratio, and thus, it has a higher rule-in value than PCT.

Topics: C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Exudates and Transudates; Humans; Pleural Effusion; Protein Precursors; Sensitivity and Specificity

The role of procalcitonin (PCT) in parapneumonic pleural effusion (PPPE) as a diagnostic and prognostic biomarker of the outcome has not been examined before.. From the emergency department, 82 adult patients with pleural effusions were enrolled in this prospective study and divided into the following two groups: the PPPE group (n = 45); and the non-PPPE group (n = 37). Levels of pleural fluid (PF) PCT and serum (S) PCT were determined in all patients after study enrollment as well as on day 3 only in the PPPE group by a newly developed time-resolved, amplified, cryptate emission assay.. Both PF-PCT and S-PCT levels were significantly higher in the PPPE group than the non-PPPE group (p = 0.01 and 0.0003, respectively). S-PCT had a better diagnostic performance than PF-PCT, with an area under the curve of the receiver operating characteristic of 0.834 for S-PCT and 0.752 for PF-PCT (p = 0.006). In the PPPE group, both PF-PCT and S-PCT levels on days 1 and 3 were significantly higher in patients who were in high-severity risk classes (all p values < 0.05). Day 3 PF-PCT/S-PCT ratios were significantly lower in patients who needed chest tube drainage for > 7.5 days (corrected p = 0.02).. S-PCT has higher diagnostic accuracy than PF-PCT in differentiating PPPEs from non-PPPEs. However, both PF-PCT and S-PCT are useful in the severity assessment of patients with PPPEs. The PF-PCT/S-PCT ratio may help to predict prolonged chest tube drainage.

Topics: Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pleural Effusion; Pneumonia; Predictive Value of Tests; Prognosis; Prospective Studies; Protein Precursors; Reproducibility of Results; ROC Curve; Severity of Illness Index

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Child, Preschool; Community-Acquired Infections; Female; Humans; Infant; Male; Pleural Effusion; Pneumonia; Prospective Studies; Protein Precursors

In patients with refractory pleural effusion or pneumothorax, fever and elevated level of white blood cell count (WBC) are frequently observed after chemical pleurodesis with intrapleural injection of OK-432, which make it difficult to differentiate whether it was from the side effects of OK-432 or concurrent bacterial infection.. Procalcitonin (PCT) levels were measured before and after pleurodesis so as to discuss whether PCT is useful for distinguishing between the side effects of OK-432 and concurrent bacterial infection.. Twenty-six patients with refractory pleural effusion or pneumothorax who underwent chemical pleurodesis with intrapleural injection of OK-432 at the First Affiliated Hospital of Sun Yat-sen University between August 2010 and August 2012 were included in our study. Levels of PCT and WBC were measured before and after pleurodesis.. Of all 26 patients, 22 patients were with refractory pleural effusion, and the other four were with pneumothorax. The median serum levels of PCT and WBC elevated from 0.155 to 1.470 ng/mL (P = 0.009) and from 5.920 to 10.475 × 10(9) /L (P = 0.000), respectively. No patient was given antibiotics and fever subsided.. Intrapleural injection of OK-432 could increase the serum level of PCT and WBC with no bacterial infection. The serum PCT level may not be useful to distinguish whether fever was caused by the side effects of OK-432 or concurrent bacterial infection.

Topics: Adult; Aged; Antineoplastic Agents; Bacterial Infections; Calcitonin; Calcitonin Gene-Related Peptide; Comorbidity; Female; Humans; Male; Middle Aged; Picibanil; Pleural Effusion; Pleurodesis; Pneumothorax; Protein Precursors; Young Adult

Data on the etiologies of pneumonia among children are inadequate, especially in developing countries. The principal objective is to undertake a multicenter incident case-control study of <5-year-old children hospitalized with pneumonia in developing and emerging countries, aiming to identify the causative agents involved in pneumonia while assessing individual and microbial factors associated with the risk of severe pneumonia.. A multicenter case-control study, based on the GABRIEL network, is ongoing. Ten study sites are located in 9 countries over 3 continents: Brazil, Cambodia, China, Haiti, India, Madagascar, Mali, Mongolia, and Paraguay. At least 1,000 incident cases and 1,000 controls will be enrolled and matched for age and date. Cases are hospitalized children <5 years with radiologically confirmed pneumonia, and the controls are children without any features suggestive of pneumonia. Respiratory specimens are collected from all enrolled subjects to identify 19 viruses and 5 bacteria. Whole blood from pneumonia cases is being tested for 3 major bacteria. S. pneumoniae-positive specimens are serotyped. Urine samples from cases only are tested for detection of antimicrobial activity. The association between procalcitonin, C-reactive protein and pathogens is being evaluated. A discovery platform will enable pathogen identification in undiagnosed samples.. This multicenter study will provide descriptive results for better understanding of pathogens responsible for pneumonia among children in developing countries. The identification of determinants related to microorganisms associated with pneumonia and its severity should facilitate treatment and prevention.

Topics: Anti-Bacterial Agents; Bacteria; Brazil; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cambodia; Case-Control Studies; Child, Preschool; China; Clinical Protocols; Developing Countries; Female; Haiti; Humans; India; Infant; Madagascar; Male; Mali; Mongolia; Paraguay; Pleural Effusion; Pneumonia; Protein Precursors; Viruses

Differential diagnosis of exudative pleural effusions can be difficult, despite the use of several biomarkers. Serum procalcitonin (s-PCT) is a well-known biomarker for systemic bacterial infections. However, the usefulness of pleural fluid procalcitonin (pf-PCT) in clinical practice has not been established. This study evaluated the usefulness of PCT measurements in differentiating parapneumonic effusion (PPE) from tuberculous (TB) pleurisy or malignant effusion.. Ninety eight adult patients diagnosed with exudative pleural effusion were enrolled and allocated into the PPE group (n=32), TB pleurisy group (n=40), or malignant effusion group (n=26). Both s-PCT and pf-PCT concentrations were measured at admission using an immunoluminometric assay.. Both s-PCT and pf-PCT were significantly increased in the PPE group compared with the TB pleurisy or malignant effusion groups (p<0.001). The optimal cut-off value for s-PCT in the diagnosis of PPE was 0.18 ng/mL (sensitivity 83.3%, specificity 81.0%). The pf-PCT cut-off value was 0.16 ng/mL (sensitivity 81.5%, specificity 72.1%). Serum PCT exhibited better diagnostic accuracy than pf-PCT, with areas under the receiver operating characteristic curves of 0.842 for s-PCT and 0.784 for pf-PCT (p=0.015). In addition, s-PCT and pf-PCT showed better diagnostic accuracy than serum C-reactive protein (p=0.005 and p=0.023, respectively).. Measurement of s-PCT and pf-PCT is useful in differentiating PPE from TB pleurisy and malignant effusion. Both s-PCT and pf-PCT may be useful biomarkers in the differential diagnosis of exudative pleural effusions.

Topics: Adult; Aged; Area Under Curve; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pleural Effusion; Pleural Effusion, Malignant; Protein Precursors; Sensitivity and Specificity; Tuberculosis, Pleural

To determine the diagnostic value of pleural fluid procalcitonin (PF-PCT) and serum PCT (S-PCT) levels in the diagnosis of parapneumonic pleural effusion (PPPE).. Sixty five inpatients with exudative pleural fluid were consecutively included in this prospective study. Biochemical (total protein, albumin, LDH, glucose, pH, PCT) studies were performed in concurrently obtained pleural fluid and venous blood samples, cytologic and microbiologic (acid-fast bacillus smear/culture, nonspecific bacterial Gram stain/culture, fungal culture) studies were performed in pleural fluid. The patients were grouped as PPPE (n= 33) and non-PPPE (n= 32) after the diagnoses were definitely established.. A total of 65 patients (M/F: 38/27; age: 57.53 ± 18.46 years) with exudative pleural fluids were assessed. In the 33 with PPPEs, 6 simple PPPEs, 5 complicated PPPEs and 22 empyemas were determined whereas in the 32 non-PPPEs, 9 tuberculous, 10 malignant, 6 paramalignant, 5 non-specific effusions and 2 chylothoraces were determined. Compared with the non-PPPE group, more fever, pneumonic infiltrations and fluid loculation, higher sedimentation, leukocyte, fluid LDH besides lower fluid glucose, pH, albumin and protein together with lower serum LDH were determined in the PPPE group (p< 0.05). Higher PS-PCT (1.03 ± 1.27 vs. 0.06 ± 0.06 ng/mL) and S-PCT levels (0.90 ± 1.44 vs. 0.05 ± 0.02 ng/mL) were determined in the PPPE group (p= 0.000). In the PPPE group, PS-PCT and S-PCT showed positive correlation with each other while PS-PCT did with sedimentation, leukocyte, CURB-65 and serum LDH, and S-PCT did with sedimentation, CURB-65 and duration of hospitalization. ROC curve, a specificity of 96.9% and a sensitivity of 57.5% were determined for an optimal PS-PCT cut-off level (0.285 ng/mL), and a specificity of %96.9 and a sensitivity of %66.6 for an optimal S-PCT cut-off level (0.105 ng/mL) that could differentiate PPPE.. PS/S-PCT levels were found to be highly efficient in excluding PPPE but not sufficiently reliable in the diagnosis of it. However, these findings should be reassessed in a larger group of cases that have not been given any antibiotic/anti-inflammatory treatment.

Topics: Adult; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Empyema; Exudates and Transudates; Female; Humans; L-Lactate Dehydrogenase; Male; Middle Aged; Pleural Effusion; Prospective Studies; Protein Precursors; ROC Curve; Sensitivity and Specificity

This study was to determine the diagnostic value of procalcitonin (PCT) in the differentiation of infectious and non-infectious causes of pleural effusion. From January 2005 to April 2005, we measured the PCT levels of pleural effusion from 76 patients using an immunoluminometric assay. The types of pleural infusions studied were para-pneumonic effusion (n = 26), empyema (n = 7), tuberculous pleurisy (n = 8), malignant pleural effusion (n = 25) and transudative pleural effusion (n = 8). The PCT levels were low in transudative pleural effusions (0.188 ± 0.077 ng/mL) and tuberculous pleurisy (0.130 ± 0.069 ng/mL), but high in empyema (5.147 ± 3.056 ng/mL), para-pneumonic effusion (1.091 ± 0.355 ng/mL), and malignant pleural effusion (0.241 ± 0.071 ng/mL). The receiver-operating characteristic curve analysis for an optimal discrimination between empyema and para-pneumonic effusion from non-para-pneumonic effusion could be performed at a cut-off point of 0.18 ng/mL with area under the curve of 0.776 (sensitivity: 69.7%, specificity: 72.1%). The correlation was found between pleural effusion PCT and serum PCT levels in 16 patients (r² = 0.967, p < 0.001). In conclusion, a high pleural effusion PCT level suggests the presence of empyema and para-pneumonic effusion.

Topics: Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Empyema; Exudates and Transudates; Female; Humans; Male; Middle Aged; Pleural Effusion; Pleural Effusion, Malignant; Pneumonia; Protein Precursors; ROC Curve; Sensitivity and Specificity; Tuberculosis, Pleural

Procalcitonin (PCT) and C-reactive protein (CRP) measurements in pleural fluid and plasma have been proposed to facilitate differential diagnosis of pleural effusion (PE). The primary aim of this study was to evaluate the usefulness of these measurements when differentiating between benign (BPE) and malignant pleural effusion (MPE).. We prospectively studied 100 patients with the specific diagnosis of exudative PE. We analyzed the demographic data and the usual biochemical studies in PE. CRP and PCT were measured in pleural fluid and plasma before starting treatment.. The CRP levels in pleural fluid were higher in patients with BPE than in patients with MPE [33.1 mg/L (16.8 to 52.1) vs. 11.8 (5.1 to 22); p = 0.001], as were the plasma CRP levels [68.4 mg/L (26.1 to 119.1) vs. 30.2 (11.7 to 64.8); p = 0.007]. No differences in PCT levels were detected between the two patient populations. The AUC derived from the ROC curve analysis for plasma CRP and pleural fluid CRP were 0.667 (CI 95%: 0.551 - 0.782) and 0.752 (CI 95%: 0.653 - 0.852), respectively. Plasma CRP levels > or = 35.5 mg/L exhibited 71% sensitivity and 56% specificity in discriminating between BPE and MPE. Pleural fluid CRP levels > or = 16.7 mg/L had 75% sensitivity and 68% specificity in the diagnosis of BPE.. CRP levels in the pleural fluid and plasma were higher in patients with BPE, particulary infectious PE. However, the measurement of CRP and PCT is not a useful parameter for discriminating between BPE and MPE and does not provide useful information in clinical practice.

Topics: Adenocarcinoma; Adult; Aged; Biomarkers, Tumor; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Carcinoma; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Lymphoma, T-Cell; Male; Mesothelioma; Middle Aged; Neoplasm Proteins; Neoplasms; Pleural Effusion; Pleural Effusion, Malignant; Pleurisy; Prospective Studies; Protein Precursors; Sensitivity and Specificity

Conventional methods to establish pleural infection are time-consuming and sometimes inadequate. Biomarkers may aid in making rapid diagnosis of infection. In an observational study we evaluated and compared the diagnostic value of pleural fluid levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), C-reactive protein and procalcitonin in intensive care patients with pleural effusions.. Thirty-six patients with de novo pleural effusions were included and 20 patients with pleural effusions after cardiothoracic surgery and 20 patients with pleural effusions after esophagus surgery acted as controls. Levels of sTREM-1, C-reactive protein and procalcitonin were measured in pleural effusions.. Levels of sTREM-1 were highest in empyemas, followed by infectious exudates. Levels of sTREM-1 were low in transudates and non-infectious exudates. C-reactive protein levels were highest in exudates and empyemas, while procalcitonin levels were highest in exudates. Pleural fluid with positive culture results contained higher sTREM-1 and C-reactive protein levels as compared to samples with negative culture results. A cut-off level of 50pg/mlsTREM-1 yielded a sensitivity of 93% and a specificity of 86%, while these were 87% and 67% respectively for a cut-off value of 7.5microg/ml C-reactive protein, and 60% and 64% respectively for a cut-off value of 0.15 ng/ml procalcitonin.. sTREM-1 is superior to C-reactive protein and procalcitonin in detecting infection.

Topics: Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Membrane Glycoproteins; Middle Aged; Pleural Effusion; Protein Precursors; Receptors, Immunologic; ROC Curve; Triggering Receptor Expressed on Myeloid Cells-1

Pleural effusion is relatively common in pneumonia. Because traditional methods for its diagnosis are not always effective, there is a need for new biomarkers to make its differential diagnosis easier.. A total of 233 patients with pleural effusion were admitted to our hospital between 2005 and 2008. Total and differential leukocyte counts, along with blood and pleural fluid procalcitonin and C-reactive protein (CRP) were performed on all of them. The patients were classified into 5 groups depending on the cause of their effusion: (1) parapneumonic, n = 28; (2) tuberculous, n = 49; (3) neoplastic, n = 57; (4) miscellaneous, n = 46; and (5) transudates, n = 53.. Procalcitonin levels were higher in the pleural fluid of the parapneumonic group (PAR, 0.15 ng/mL) compared with those of the rest of the groups, but statistically significant differences were only observed with the miscellaneous and tuberculous groups (P < 0.001). Levels of CRP were also higher in the PAR (0.67 mg/L) compared with those of the rest of the groups, with statistically significant differences observed (P < 0.001-0.004) in all of them. The parameter with the largest area under the receiver operator characteristics curve was the product of the total neutrophil count and the CRP in the pleural fluid, in which an area of 0.836 had a sensitivity of 64.3% and a specificity of 93.4%.. Determination of procalcitonin and CRP, in the pleural fluid and blood, does not seem to provide great value to the diagnosis of PAR. However, calculating the product of the total neutrophil count and the CRP may be useful in the diagnosis of these effusions because increased values have a high specificity and predictive values.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Leukocyte Count; Male; Paraneoplastic Syndromes; Pleural Effusion; Pneumonia; Predictive Value of Tests; Protein Precursors; ROC Curve; Tuberculosis

We aimed to investigate whether pleural fluid concentrations of biomarkers for bacterial infection, namely triggering receptor expressed on myeloid cells (sTREM-1), procalcitonin (PCT), lipopolysaccharide-binding protein (LBP) and C-reactive protein (CRP), might identify infectious effusions and discriminate between complicated (CPPEs) and uncomplicated parapneumonic effusions (UPPEs). Stored pleural fluid samples from 308 patients with different causes of pleural effusion were used to measure the four biomarkers. Receiver-operating characteristic analysis determined the accuracy of the new tests. Median pleural fluid levels of CRP, sTREM-1 and LBP were significantly higher in CPPE compared with those in other aetiologies. The area under the curve for distinguishing infectious (parapneumonics and tuberculosis) from noninfectious effusions was 0.87 for CRP, 0.86 for sTREM-1, 0.57 for PCT and 0.87 for LBP. Regarding the discrimination of nonpurulent CPPE versus UPPE, a multivariate analysis found that pleural fluid glucose < or =60 mg x dL(-1), LBP > or =17 microg x mL(-1) and CRP > or =80 mg x L(-1) were the best parameters. Individually, none of the new biomarkers achieved better performance characteristics than pH, glucose or lactate dehydrogenase in labelling CPPE. In conclusion, elevated pleural fluid levels of CRP, sTREM and LBP identify patients with infectious effusions, particularly those with CPPE. PCT has no value for the differential diagnosis of pleural effusions.

Topics: Acute-Phase Proteins; Adult; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Carrier Proteins; Diagnosis, Differential; Female; Humans; Lipopolysaccharides; Male; Membrane Glycoproteins; Middle Aged; Pleural Effusion; Protein Precursors; Pulmonary Medicine; Receptors, Immunologic; Triggering Receptor Expressed on Myeloid Cells-1

This study evaluated the value of procalcitonin (PCT) levels in pleural effusion to differentiate the etiology of parapneumonic effusion (PPE). Forty-one consecutive PPE patients were enrolled and were divided into bacterial and non-bacterial PPE. Blood and pleural effusion samples were collected for PCT measurement on admission and analyzed for diagnostic evaluation. PCT of pleural fluid was significantly increased in the bacterial PPE group (0.24 ng/mL) compared to the non-bacterial PPE group (0.09 ng/mL), but there was no significant difference for serum PCT. A PCT concentration of pleural fluid >0.174 ng/mL (best cut-off value) was considered positive for a diagnosis of bacterial PPE (sensitivity, 80%; specificity, 76%; AUC, 0.84). Pleural effusion PCT in the bacterial PPE is significantly different from those of the non-bacterial PPE and control groups, so the diagnostic use of PCT still warrants further investigation.

Topics: Aged; Bacterial Infections; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pleural Effusion; Pneumonia; Predictive Value of Tests; Protein Precursors; ROC Curve

This study was designed to identify major risk factors of PCTS and elucidate the possibility of early laboratory diagnosis of this syndrome for the choice of optimal therapeutic strategy. Retrospective analysis covered medical records of 500 patients who had experienced open heart surgery. Prospective studies included 60 patients of whom 50 had clinical manifestations of PCTS. Risk of its development depended on the severity of the underlying disease and increased after mechanical revascularization of myocardium. Urgency surgical intervention and greater extent of coronary shunting increased the probability of PCTS. Results of the measurement of serum procalcitonin by a highly sensitive method and of relative content of different protein fractions in serum and pleural/pericardial fluid suggest high informative value of these methods as diagnostic tools for PCTS. Preventive treatment with non-steriodal anti-inflammatory agents decreased the incidence of PCTS by 53%.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Biomarkers; Blood Proteins; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Early Diagnosis; Female; Humans; Male; Middle Aged; Pericardial Effusion; Pleural Effusion; Postpericardiotomy Syndrome; Prospective Studies; Protein Precursors; Retrospective Studies; Risk Factors

The paper analyzes the diagnostic value of methods for the laboratory diagnosis of postpericardiotomy syndrome (PPS) in patients who have undergone open heart surgery. The prospective study included 63 patients, of whom 53 had the clinical manifestations of PPS. Ultrasensitive assay of serum procalcitonin and the determination of relative albumin levels in pleural and pericardial fluids are noted to be of high diagnostic value.

Topics: Adenosine Deaminase; Blood Proteins; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; L-Lactate Dehydrogenase; Pericardial Effusion; Pleural Effusion; Postpericardiotomy Syndrome; Prospective Studies; Protein Precursors

Diagnosis of tuberculous pleuritis is difficult because of its nonspecific clinical presentation and decreased efficiency of traditional diagnostic methods. We investigated the use of procalcitonin (PCT) concentration in tuberculous pleuritis diagnosis.. A prospective clinical study was performed with two different patient groups. A total of 28 patients were included: 18 with tuberculosis and 10 with nontuberculous pleurisy. Serum and pleural fluid PCT concentrations were evaluated before treatment.. Serum and pleural fluid PCT concentrations were statistically different between tuberculous and nontuberculous pleurisy groups (P = 0.012 and P = 0.004, respectively), even though they were not elevated in relation to the cut-off level of 0.5 ng/mL. A positive and significant correlation was detected between serum and pleural fluid PCT levels (r = 0.49, P = 0.008). Diagnostic specificity and sensitivity values for serum and pleural fluid PCT in discriminating tuberculous from nontuberculous pleurisy were 80% and 72.2%, and 90% and 66.7% at the 0.081 and 0.113 ng/mL cut-off values, respectively.. Relative to the current cut-off level of 0.5 ng/mL, PCT concentration is not a useful parameter for the diagnosis of tuberculous pleurisy. Because there were PCT levels in patients with tuberculous pleurisy that were below the current cut-off level but were significantly different from those of the nontuberculous group, the use of PCT should be further investigated.

Topics: Adolescent; Adult; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pleural Effusion; Pleurisy; Prospective Studies; Protein Precursors; Reference Values; Sensitivity and Specificity; Tuberculosis, Pleural