Procalcitonin as a diagnostic marker in differentiating parapneumonic effusion from tuberculous pleurisy or malignant effusion

Clin Biochem. 2013 Oct;46(15):1484-8. doi: 10.1016/j.clinbiochem.2013.03.018. Epub 2013 Apr 6.


Objectives: 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.

Design and methods: 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.

Results: 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).

Conclusions: 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.

Keywords: ADA; AUC; Biologic markers; C-reactive protein; CRP; LDH; Parapneumonic effusion; Pleural effusion; Procalcitonin; ROC; TB; adenosine deaminase; area under the curve; lactate dehydrogenase; pf-PCT; pleural fluid procalcitonin; receiver operating characteristic; s-PCT; serum procalcitonin; tuberculous.

MeSH terms

  • Adult
  • Aged
  • Area Under Curve
  • Biomarkers / metabolism
  • Calcitonin / metabolism*
  • Calcitonin Gene-Related Peptide
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pleural Effusion / diagnosis*
  • Pleural Effusion / metabolism
  • Pleural Effusion, Malignant / diagnosis*
  • Pleural Effusion, Malignant / metabolism
  • Protein Precursors / metabolism*
  • Sensitivity and Specificity
  • Tuberculosis, Pleural / diagnosis*
  • Tuberculosis, Pleural / metabolism


  • Biomarkers
  • CALCA protein, human
  • Protein Precursors
  • Calcitonin
  • Calcitonin Gene-Related Peptide