Evaluation of prognostic value of selected biochemical markers in surgically treated patients with acute mediastinitis

Abstract

SummaryBackgroundMonitoring of biochemical markers of inflammation in acute mediastinitis (AM) can be useful in the modification of treatment. This study was a retrospective evaluation of selected biochemical parameters with negative impact on the prognosis in surgically treated patients.Material/MethodsThere were 44 consecutive patients treated surgically due to AM of differentiated etiology. Selected biochemical markers (WBC, RBC, HGB, HCT, PLT, CRP, PCT, ionogram, protein and albumins) were assessed before surgery and on the 3rd day after surgery. ANOVA was applied to find factors influencing observations. Numerical data [laboratory parameters] were compared by means of medians.ResultsThe overall hospital mortality rate was 31.82%. In the group of dead patients, there were observed statistically significant lower mean preoperative values of RBC [p=0.0090], HGB [p=0.0286], HCT [p=0.0354], protein [p= 0.0037], albumins [p=0.0003] and sodium [p<0.0001] and elevated values of CRP [P=0.0107] and PCT p<0.0001]. High level of inflammatory markers on day 3 after surgery was found to increase the risk of death – for WBC (by 67%), for CRP (by 88%) and for PCT (by 100%).ConclusionsPoor prognosis was more frequent in patients with preoperative high levels of CRP, PCT, anemia, hypoproteinemia and hyponatremia. The risk of death increases significantly if in the immediate postoperative period no distinct decrease in WBC count and of the CRP and PCT level is observed. In such a situation the patients should be qualified earlier for broadened diagnostic workup and for reoperation.

Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description

“…We did not find randomized controlled trials or clinical practice guidelines published on the diagnosis and treatment of descending necrotizing mediastinitis; the best available evidence in adults was obtained from 26 published studies of clinical reviews of 4 or more cases of descending necrotizing mediastinitis with evidence level III (Table ).…”

“…This study is the first systematic review of the treatment of descending necrotizing mediastinitis in the last 6 years, which includes a series of 4 or more cases published from 2009 to 2014, comparing mortality with the published revisions of earlier periods, which shows a decline since the year 2000, which has been sustained to this date (Table ).…”

“…Isolated case reports or series with less than 4 cases of descending necrotizing mediastinitis, which have low evidence level (IV), were not included for the purpose of analysis in this review. Reports of descending necrotizing mediastinitis published before the year 2009 were also not included because there are reviews of accumulated cases from the period from 1969 to 1989, from 1970 to 1997, and from 1998 to 2008, along with 5 meta‐analysis of these periods; all other case series published between 2009 to 2014 were included …”

Evaluation of Recovery in Iatrogenic Evoked Acute Mediatinitis

“…Deviation from their values often anticipates clinical symptoms. Systematic analysis of biochemical parameters revealed significant importance of detailed examination of patients in AM [5]. …”

“…The statistical analyses performed earlier demonstrated higher mean number of WBC in the group of patients with AM who died [5]. Therefore, inclusion of this parameter into the group of factors determining “inflammatory status” seems to be appropriate, not purely from the mathematical point of view.…”