Osornio-Ochoa JG, Marmolejo-Hernández I, García-Jiménez E, Alemán-Villalobos A

Language: English
References: 11
Page: 140-144
PDF size: 986.50 Kb.

ABSTRACT

Introduction: pleural empyema may require surgical intervention despite initial chest tube drainage. Early identification of patients at risk of conservative treatment failure is critical. Complete blood count-derived indices, including the neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratios have shown prognostic value in inflammatory conditions, but their role in empyema remains unclear. Objective: to assess the predictive ability of neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratios to anticipate surgical need in patients with empyema initially treated with chest tube drainage. Material: observational, retrospective, comparative study (January 2022-January 2025) at a secondary-level hospital. Adults with pleural empyema initially managed with chest tube drainage. Ratios were calculated at admission; non-parametric testing, ROC analysis and logistic regression were performed. Institutional ethics approval obtained. Results: eighty-seven patients were included (median age 56 years; 59.8% male); 78.2% required surgery. The conservative group was older (66 vs. 51.5 years) and the surgical group had a longer length of stay (22 vs. 8 days). Discriminative performance was limited. For surgery yes/no, AUCs were 0.44 (neutrophil-to-lymphocyte), 0.47 (platelet-to-lymphocyte), and 0.65 (lymphocyte-to-monocyte); for thoracotomy yes/no: 0.52, 0.53, and 0.49; and in the surgical subgroup thoracotomy vs. videoassisted thoracoscopic surgery: 0.60, 0.59, and 0.33, respectively. Conclusions: hematological indices demonstrated limited accuracy as independent predictors of surgical need in pleural empyema. The neutrophil-to-lymphocyte ratio may provide complementary information to identify patients requiring more invasive procedures; prospective validation is warranted.

REFERENCES

1. Mendes J, Santos MG, Dias G, Marinho R, Henriques F. A rarecase of necrotizing pneumonia and pleural empyema secondary totransdiaphragmatic extension and perforation of a pyogenic liverabscess. Cureus. 2024;16(9):e70273. doi: 10.7759/cureus.70273.

2. Colice GL, Curtis A, Deslauriers J, et al. Medical and surgicaltreatment of parapneumonic effusions: an evidence-based guideline.Chest. 2000;118(4):1158-1171. doi: 10.1378/chest.118.4.1158.

3. Báez-Saldaña R, Molina-Corona H, Martínez-Rendón M E, Iñiguez-García M, Escobar-Rojas A, Fortoul-Vandergoes T. Thoracic empyemain adults. Clinical aspects, microbiology and frequency of surgicaloutcome. Cir. Cir. 2021;89(1):63-70. doi: 10.24875/ciru.19001532.

4. Higuchi M, Suzuki H. Current status and prospect of medical andsurgical management for thoracic empyema. Curr Chall Thorac Surg.2020;2:39. doi: 10.21037/ccts.2020.02.09.

5. Reichert M, Hecker M, Witte B, et al. Stage-directed therapy ofpleural empyema. Langenbecks Arch Surg. 2017;402(1):15-26. doi:10.1007/s00423-016-1498-9.

6. Tsai YM, Gamper N, Huang TW, Lee SC, Chang AH. Predictorsand clinical outcomes in empyema thoracis patients presenting tothe emergency department undergoing video-assisted thoracoscopicsurgery. J Clin Med. 2019;8(10):1612. doi: 10.3390/jcm8101612.

7. Rahman NM, Maskell NA, Davies CW, et al. The relationshipbetween chest tube size and clinical outcome in pleural infection.Chest. 2010;137(3):536-543. doi: 10.1378/chest.09-1044.

8. Forero S. Diagnostic keys in adult patients with pleural effusion: narrativereview. Iatreia. 2020;33(4):348-359. doi: 10.17533/udea.iatreia.62.

9. Subotic D, Lardinois D, Hojski A. Minimally invasive thoracicsurgery for empyema. Breathe (Sheff). 2018;14(4):302-310. doi: 10.1183/20734735.

10. Lehtomäki A, Nevalainen R, Ukkonen M, Nieminen J, LaurikkaJ, Khan J. Trends in the incidence, etiology, treatment, andoutcomes of pleural infections in adults over a decade in a FinnishUniversity Hospital. Scand J Surg. 2020;109(2):127-132. doi:10.1177/1457496919832146.

11. Lin CM, Chen YL, Cheng YF, et al. Optimal timing for video assistedthoracic surgery decortication for improved survival in chronicempyema. Sci Rep. 2024;14(1):24548. doi: 10.1038/s41598-024-75569-w.