The Prognostic Value of Longitudinal C-Reactive Protein Trends in Complicated Parapneumonic Effusion and Empyema
Keywords:
C-reactive Protein, Parapneumonic Effusion, Empyema, Pleural Infection, Inflammatory MarkersAbstract
Background: Parapneumonic effusion and empyema are complications of pneumonia and are linked to significant morbidity and mortality. Yet, the early assessment of patients at risk of treatment failure has remained an area of difficulty. C-reactive protein (CRP) is a biomarker of inflammation that has widespread clinical utility. The utility of CRP trend analysis in patients suffering from pleural infections has remained unproven. Objective: To determine the relationship between the trend of C-reactive protein levels in patients and clinical outcomes in the treatment of complicated parapneumonic effusion and empyema. Methodology: One hundred and sixty adult patients suffering from complicated parapneumonic effusion and/or empyema were included in a prospective observational study. CRP values at admission and during treatment (on Day 3, Day 7, and discharge) were determined. Multivariate logistic regression analysis was used to differentiate independent predictors for treatment failure and mortality. Results: A total of 95 (59.4%) patients showed a rapid decline in CRP, 50 (31.3%) showed a slow decline, while 15 (9.3%) showed persistent elevation. Multivariate analysis showed that the persistently elevated CRP levels as an independent predictor for treatment failure (OR = 6.8, 95% CI 2.4-19.2, p < 0.001) and mortality (OR = 9.1, 95% CI 2.1-39.5, p = 0.003). Conclusion: Serum CRP dynamics within a series of patients is an independent predictor of clinical outcome for complicated parapneumonic effusion and empyema. The rapid decrease of CRP values predicts favorable outcome, while persistent elevation is a marker of patients who are at high risk for treatment failure, complications, or death.References
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