Osornio-Ochoa, José G; Marmolejo-Hernández, Issadora; García-Jiménez, Emilio; Alemán-Villalobos, Alfonso

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.

  FULL TEXT PDF