We aimed to evaluate the diagnostic and prognostic value of measuring survivin levels, which is an inhibitor of apoptosis in pleural effusions. Methods: Group I, malignant (MPE) (n = 51); Group II, tuberculosis (TPE) (n = 18); Group III transudative (TE) (n = 9) effusions were enrolled prospectively. We used ELISA to analyze 78 effusions. The value for the differential diagnosis and the correlation between survivin and survival in MPE were analyzed. Results: Survivin level was 41.75 +/- 76.20 in MPE, 15.83 +/- 10.92 in TPE and 8.33 +/- 8.67 in TE. When the patients divided two groups as malignant and non-malignant pleural effusion (non-MPE), survivin level was significantly higher in MPE (41.75 +/- 76.20) than in non-MPE (13.33 +/- 2.05) (p = 0.012). The cutoff value for survivin levels detected by ROC curve analysis was 7.5 pg/ml, with sensitivity and specificity values of 72%, 44%, respectively. Survivin had no discriminative power in differentiating exudative effusions of MPE from TPE (p = 0.405). There was no correlation between survivin level and age, sex, location, fluid pH, glucose, protein, albumine and ADA level while there was significant moderate correlation with fluid LDH (r = 0.49; p < 0.001). Survivin levels can distinguish patients who had poor prognosis (median survival 75 days, n = 24) and those who had good prognosis (median survival 219 days, n = 27, p = 0.03) in MPE.