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C-REACTIVE PROTEIN AND PLEURAL EMPYEMA SURGICAL TREATMENT
October 2009, Vol 136, No. 4_MeetingAbstracts Abstract: Poster Presentations | October 2009
C-REACTIVE PROTEIN AND PLEURAL EMPYEMA SURGICAL TREATMENT Ricardo M. Terra; Israel L. Medeiros, MD; Esther M. Choi; Paulo M. Pego-Fernandes, MD; Fabio B. Jatene, MD University of Sao Paulo, Sao Paulo, Brazil Chest Chest. 2009;136(4_MeetingAbstracts):134S. doi:10.1378/chest.08-2448 Abstract PURPOSE: Evaluate C- Reactive Protein(CRP) levels before and in the early postoperative period after pleural empyema (PE) surgical treatment and correlate CRP preoperative levels with treatment failure. METHODS: Retrospective chart review of consecutive patients who underwent chest tube drainage or VATS decortication due to Phase I/II PE between July 2007 and January 2009. We collected the following data: gender, age, comorbidities, surgical procedure, complications, reoperations, mortality, serum CRP levels before treatment (pre) and 48, 96 and 168 hours after surgical treatment (48h, 96h and 168h respectively). Blood leukocytes count and axilar temperature were also recorded. ANOVA and Bonferroni post-test were used to analyze CRP results and logistic regression to identify predictive factors of treatment failure (hospital or 30day moratlity or reoperation). RESULTS: Forty nine patients underwent surgical treatment for PE during the study period, but 7 were excluded due to incomplete recordings. Therefore, 42 patients (27 men, 15 women), age average 54.3 years were included, 25 of them had comorbidities. Average CRP levels were: pre 156.1 ± 98.1, 48h 130.7 ± 67.3, 96h 131.5 ± 65.3, 168h 110.4 ± 49.5 (p = 0.04, ANOVA), significant difference was observed only between preoperative and 7th day CRP levels. There was no correlation among postoperative CRP levels, leukocyte count and axilar temperature. Thirteen treatment failures were observed (8 died, 5 reoperations). Preoperative CRP levels were highly variable among the studied patients (8.06–434) and logistic regression showed no correlation between preoperative CRP levels and treatment outcome (OR 1.0, p = 0.9). Renal failure(OR 22.4, p = 0.05) and neoplasia (OR 6.3, p = 0.05) were predictive factors of failure. CONCLUSION: In the present study we observed that after PE surgical treatment a progressive decrease in serum CRP levels occurred which became significant in the 7th postoperative day. No correlation between preoperative CRP levels and treatment failure was observed. CLINICAL IMPLICATIONS: Our data suggest that CRP serum levels in patients who underwent an invasive treatment for PE have a slow decline in the postoperative period and that clinical factors are more correlated with mortality and reoperation than preoperative CRP levels. DISCLOSURE: Ricardo Terra, No Financial Disclosure Information; No Product/Research Disclosure Information Wednesday, November 4, 2009 12:45 PM - 2:00 PM
C-REACTIVE PROTEIN AND PLEURAL EMPYEMA SURGICAL TREATMENT Ricardo M. Terra; Israel L. Medeiros, MD; Esther M. Choi; Paulo M. Pego-Fernandes, MD; Fabio B. Jatene, MD University of Sao Paulo, Sao Paulo, Brazil Chest Chest. 2009;136(4_MeetingAbstracts):134S. doi:10.1378/chest.08-2448 Abstract PURPOSE: Evaluate C- Reactive Protein(CRP) levels before and in the early postoperative period after pleural empyema (PE) surgical treatment and correlate CRP preoperative levels with treatment failure. METHODS: Retrospective chart review of consecutive patients who underwent chest tube drainage or VATS decortication due to Phase I/II PE between July 2007 and January 2009. We collected the following data: gender, age, comorbidities, surgical procedure, complications, reoperations, mortality, serum CRP levels before treatment (pre) and 48, 96 and 168 hours after surgical treatment (48h, 96h and 168h respectively). Blood leukocytes count and axilar temperature were also recorded. ANOVA and Bonferroni post-test were used to analyze CRP results and logistic regression to identify predictive factors of treatment failure (hospital or 30day moratlity or reoperation). RESULTS: Forty nine patients underwent surgical treatment for PE during the study period, but 7 were excluded due to incomplete recordings. Therefore, 42 patients (27 men, 15 women), age average 54.3 years were included, 25 of them had comorbidities. Average CRP levels were: pre 156.1 ± 98.1, 48h 130.7 ± 67.3, 96h 131.5 ± 65.3, 168h 110.4 ± 49.5 (p = 0.04, ANOVA), significant difference was observed only between preoperative and 7th day CRP levels. There was no correlation among postoperative CRP levels, leukocyte count and axilar temperature. Thirteen treatment failures were observed (8 died, 5 reoperations). Preoperative CRP levels were highly variable among the studied patients (8.06–434) and logistic regression showed no correlation between preoperative CRP levels and treatment outcome (OR 1.0, p = 0.9). Renal failure(OR 22.4, p = 0.05) and neoplasia (OR 6.3, p = 0.05) were predictive factors of failure. CONCLUSION: In the present study we observed that after PE surgical treatment a progressive decrease in serum CRP levels occurred which became significant in the 7th postoperative day. No correlation between preoperative CRP levels and treatment failure was observed. CLINICAL IMPLICATIONS: Our data suggest that CRP serum levels in patients who underwent an invasive treatment for PE have a slow decline in the postoperative period and that clinical factors are more correlated with mortality and reoperation than preoperative CRP levels. DISCLOSURE: Ricardo Terra, No Financial Disclosure Information; No Product/Research Disclosure Information Wednesday, November 4, 2009 12:45 PM - 2:00 PM