Utility of C-reactive protein measurements for empyema diagnosis after pneumonectomy

Ann Thorac Surg. 1994 Apr;57(4):933-6. doi: 10.1016/0003-4975(94)90206-2.


Serum C-reactive protein (CRP) levels were studied serially during the postoperative period in 151 consecutive patients who underwent pneumonectomy. Virtually all patients who had a simple postoperative course (115 of 120), as well as 9 patients who had a bronchial infection of the remaining lung, 3 with a pulmonary embolus, and 2 who suffered postoperative bleeding requiring reoperation, demonstrated a similar postoperative evolution in their CRP values: a rapid postoperative rise until a peak or a plateau (mean peak value, 132 +/- 25 mg/L) was reached within 3 to 6 days, followed by a progressive decline to a value of less than 75 mg/L on day 9, and less than 50 mg/L on day 12. Conversely, all 12 patients who suffered empyema postoperatively, as well as 3 patients with bacterial pneumonia, 1 patient with chylothorax, and 1 patient with inflammatory pericarditis, demonstrated either a markedly persistent elevation in their CRP values or a secondary rise in the levels which exceeded 100 mg/L. Because of the high sensitivity (100%) and specificity (91.4%) of the CRP levels in detecting postpneumonectomy empyema, we recommend the routine use of this measure. Furthermore, a low CRP value after pneumonectomy (less than 50 mg/L) may help in deciding whether to confidently discharge a patient from the hospital in the absence of empyema. The negative predictive value of this method was found to be 100%.

MeSH terms

  • Aged
  • Bacterial Infections / blood
  • Bacterial Infections / epidemiology
  • Bacterial Infections / etiology
  • C-Reactive Protein / analysis*
  • Empyema, Pleural / blood*
  • Empyema, Pleural / epidemiology
  • Empyema, Pleural / etiology
  • Evaluation Studies as Topic
  • Hemothorax / blood
  • Hemothorax / epidemiology
  • Hemothorax / etiology
  • Humans
  • Leukocyte Count
  • Lung Diseases / blood
  • Lung Diseases / epidemiology
  • Lung Diseases / etiology
  • Middle Aged
  • Pneumonectomy / adverse effects*
  • Pulmonary Embolism / blood
  • Pulmonary Embolism / epidemiology
  • Pulmonary Embolism / etiology
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Survival Rate
  • Time Factors


  • C-Reactive Protein