Albumin and leukocyte: pre-operative factors for advanced management in pleural empyema?

Background: Surgical intervention such as video-assisted thoracoscopic surgery (VATS) has shown the benefit of reducing morbidity and mortality in the management of pleural empyema. The objective of the study was to investigate preoperative factors that could predict the need for VATS rather than chest tube thoracostomy.Methods: This is retrospective observational study of consecutive patients diagnosed with pleural empyema admitted to the Dr. Zainoel Abidin Hospital, Banda Aceh in period of 2015 to 2017. The demographic, clinical dan laboratory data of the patients were evaluated from hospital medical records.Results: A total of 48 consecutive patients were identified. The mean age of the patients was 34.3 ± 20.4 years; and 31 (64.6%) were male. Twenty-six patients underwent VATS decortication and twenty-two patients underwent chest tube thoracostomy. Patient demographics were similar between VATS decortication and chest tube thoracostomy group. The significant preoperative factors associated with the VATS were serum albumin level and leukocytes (p <0.05). The mean serum albumin level was 2.81 ± 0.44 g/dL for the VATS decortication group vs 3.06 ± 0.41 g/dL for the chest tube thoracostomy group (p = 0.047). In addition, serum leukocyte level was higher in VATS decortication group compared to chest tube thoracostomy group (21,600 mm-3 vs 12,900 mm-3; p = 0.024).Conclusion: We demonstrate that a low serum albumin level or an elevated leukocyte level may represent as preoperative factors in which surgical treatment may be required in the management of pleural empyema.