Evaluation of serial C-reactive protein measurements after surgical treatment of pleural empyema

Abstract

OBJECTIVE:Serial C-reactive protein measurements have been used to diagnose and monitor the response to therapy in patients with pneumonia and other infectious diseases. Nonetheless, the role of C-reactive protein measurement after surgical treatment for pleural empyema is not well defined. The aim of this study is to describe the behavior of C-reactive protein levels after the surgical treatment of pleural empyema and to correlate this parameter with the patient's prognosis.METHODS:We retrospectively analyzed the records of patients with pleural empyema treated by either chest-tube drainage or surgery from January 2006 to December 2008. C-reactive protein levels were recorded preoperatively and 2 and 7 days postoperatively. The clinical outcome was binary: success or failure (mortality or the need for repeated pleural intervention).RESULTS:The study group comprised fifty-two patients. The median C-reactive protein values were as follows: 146 mg/L (pre-operative), 134 mg/L (post-operative day 2), and 116 mg/L (post-operative day 7). There was a trend toward a decrease in these values during the first week after surgery, but this difference was only statistically significant on day 7 after surgery. Over the first week after surgery, the C-reactive protein values decreased similarly in both groups (successful and failed treatment). No correlation between the preoperative C-reactive protein level and the clinical outcome was found.CONCLUSIONS:We observed that, in contrast to other medical conditions, C-reactive protein levels fall slowly during the first postoperative week in patients who have undergone surgical treatment for pleural empyema. No correlation between the perioperative C-reactive protein level and the clinical outcome was observed.

Evaluation and significance of C-reactive protein in the clinical diagnosis of severe pneumonia

“…procalcitonin and CRP in the incipient stage of acute respiratory infections increases the risk of progression to a critical disease state (12)(13)(14). An integrated evaluation of the clinical symptoms and the levels of CRP may improve the predictability of the clinical course and prognosis of pneumonia (15).…”

Does videothoracoscopy improve clinical outcomes when implemented as part of a pleural empyema treatment algorithm?

“…Pleural empyema (PE) is a significant clinical condition with a mortality rate approaching 20% ( 1 ). PE treatment consists of early drainage of the pleural space and the use of antibiotics ( 2 ). Although open thoracotomy is the classical approach for PE treatment, tube thoracostomy is generally indicated for patients with early-stage empyema, whereas patients with pleural loculations or a trapped lung should ideally undergo pleural decortication ( 1 , 2 ).…”

“…PE treatment consists of early drainage of the pleural space and the use of antibiotics ( 2 ). Although open thoracotomy is the classical approach for PE treatment, tube thoracostomy is generally indicated for patients with early-stage empyema, whereas patients with pleural loculations or a trapped lung should ideally undergo pleural decortication ( 1 , 2 ). More recently, however, video-assisted thoracic surgery (VATS) has become an attractive alternative, as many authors claim that this technique serves as a minimally invasive procedure to provide reduced morbidity and postoperative pain, improved cosmetics and fewer complications ( 3 , 4 ).…”

Methods of treatment of pleural empyema in children

“…In the abnormalities of the basic blood tests, leukocytosis with neutrocytosis, elevated erythrocyte sedimentation rate (ESR), and positive reactions to C-reactive pro-Methods of treatment of pleural empyema in children tein (CRP) are found, but these tests are not specific for this disease entity [6,21].…”