Immunological disorders in patients with acute pleural empyema

Abstract

In case of acute pleural empyema pronounced violations of cellular and humoral factors of immunity as well as non-specific resistance of the body are revealed. Dynamics of laboratory and immunological changes of 64 patients with acute pleural empyema who were treated with classical and minimally invasive surgical methods has been studied. Patients were classified into 5 groups in accordance with severity of the disease, which was determined according to the criteria which comprise such clinical and laboratory parameters as: respiratory rate, heart rate, blood pressure, temperature reaction, the number of affected particles, leukocytosis, SpO2. All the patients underwent a standard examination as well as determination of serum concentration InterLeykin 6 (IL-6), InterLeykin 8 (IL-8), Tumor Necrose Factor α (TNF-α), C-Reactive Protein (CRP). Assessment of cytokine spectrum of blood serum of patients with acute pleural empyema allows stating the condition of hypercytokinemia with an increase in pro-inflammatory cytokines. Meanwhile the degree of their increase differed depending on the severity of course of acute pleural empyema. Study of structure of cytokine status allowed identifying those patients with severe course of pleural empyema had a significant increase in IL-6 and CRP concentrations. Nevertheless, the severe course of the disease is associated with insufficient increase of IL-8 and TNF-α. Deficiency of IL-8 and to a less extent IL-6 is expressed in patients of the older age group. In the general blood test, there have been identified higher indicators of total number of leukocytes, neutrophils, pronounced shift of the leukocyte formula to the left, increases of erythrocyte sedimentation rate in patients with a severe course of the disease. There have been identified factors which affect severe course of acute pleural empyema: decrease in oxygen saturation to less than 94%, severity of shortness of breath, which exceeds 2 points on the Borg scale, damage to 3 or more segments of lung tissue, and also numerous clinical signs of violation of anti-infective protection, pronounced decrease in neutrophils, an increase in the concentration of C-reactive protein and insufficient increase of IL-8 and TNF-α in blood serum. Keywords: acute purulent diseases of the pleura, respiratory failure, interleukin 6, interleukin 8, tumor necrosis factor α, C-reactive protein.