.jpg)
.png)
Study Objectives: The aim of the study was to investigate the degree of systemic inflammation occurring with talc pleurodesis by determining serum C-reactive protein (CRP) levels, and to evaluate whether this could help to predict the success rate and/or side effects.
Materials and Methods: In a prospective trial, 43 consecutive patients with recurrent and biopsy-proven malignant effusions were included. Five grams of talc mixed in 150 ml of normal saline were administered via tube thoracostomy. Serial determinations of CRP were made in serum at the beginning of pleurodesis (baseline), and 24 h and 72 h after the procedure. Successful therapy was defined as a complete absence or minor re-accumulation of pleural effusion one month after pleurodesis.
Results: Three patients did not return for their 30-day follow-up visit and were excluded from further analysis. Pleurodesis was successful in 33 of 40 patients (82.5%). The patients had significantly higher serum CRP levels at 24 h and 72 h than at baseline. Mean serum CRP levels at baseline, 24th h and 72nd h were 5.5 mg-dL-1, 12.6 mg-dL- 1 and 26.2 mg-dL'1, respectively. Although mean serum CRP levels were higher in patients with successful pleurodesis compared with unsuccessful patients (baseline-. 5.76±5.75 mg-dL'1 & 4.42±2.96 mg-dL'1; at24h: 13.41 ±10.40 mg-dL'1 & 8.54±4.97 mg-dL-1; at 72h: 27.97+12.01 mg-dL'1 & 18.07±8.95 mg-dL-1, respectively), there was no statistical significance (p=0.199). In the ROC analysis, from the standpoint of 72nd h serum CRP level, 21 mg-dL-1 was the most relevant threshold to determine whether pleurodesis was successful. Sensitivity, specificity, and positive- and negative predictive value of this value were 66.7%, 71.4%, 91.7%, and 31.3%, respectively. Complications were not serious, and the most common side effects included fever (47.5%) and chest pain (17.5%). Patients with complications had a tendency to higher serum CRP levels at the 72nd h (27.5 ±13.3 mg-dL'1 & 24.7± 10.4 mg-dL'1), but this was not statistically significant (p=0.142).
Conclusions: The inflammatory response in the pleural cavity due to talc pleurodesis is reflected in the systemic circulation, and CRP can be used to predict response to pleurodesis with a moderate efficacy.