Shiroshita Akihiro, Takeshita Masafumi, Nishiuma Teruaki, Ota Tomoaki, Kataoka Yuki
Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Nashville, TN, 37203, USA.
Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan.
BMC Pulm Med. 2025 Jul 12;25(1):337. doi: 10.1186/s12890-025-03799-3.
Although previous studies have evaluated C-reactive protein (CRP) as a diagnostic marker for pleural empyema, the prognostic value of baseline and serial CRP measurements has not been adequately assessed. The aim of this study was to assess the association between serial measurements of serum CRP levels and mortality risk among patients with empyema.
This database research was performed using the RWD database. Patients with pleural empyema aged ≥ 40 years who underwent thoracostomy (chest tube insertion) on admission or the next day were included. The exclusion criteria were missing covariates, death within 24 h, or transfer to another hospital within 24 h. Baseline and serial CRP levels were assessed as exposures. The primary outcome was the time to death within 90 days after admission. A multivariate Cox proportional hazards model was used to evaluate the association between baseline CRP levels and death. Because the timing of CRP measurements depended on each patient’s clinical course, a joint regression model was applied to evaluate each patient’s serial serum CRP measurements and death. A joint regression model combines longitudinal data analysis for exposure with survival analysis for the outcome. We simultaneously used a linear mixed-effects model to estimate the latent trajectory of serial CRP levels and a relative risk model to estimate the association between serial CRP measurements and death, with adjustment for clinically important confounders.
We included 823 patients in the analysis. Of these, 82 (10%) died, and 85 (10%) underwent thoracic surgery. Ninety days after admission, 430 patients (52%) were censored. The log of baseline CRP levels was not associated with mortality risk (hazard ratio: 0.84 [95% confidence interval, 0.59–1.20]), whereas a higher cumulative log of serum CRP levels was associated with a higher mortality risk over time (hazard ratio: 2.08 [95% confidence interval, 3.28–5.18]).
Baseline serum CRP levels were not associated with mortality risk, whereas a serial upward trend in serum CRP levels was strongly associated with increased mortality risk. Physicians can consider serial serum CRP levels as a biomarker for monitoring the treatment response in patients with pleural empyema.
The online version contains supplementary material available at 10.1186/s12890-025-03799-3.
尽管先前的研究已将C反应蛋白（CRP）评估为胸腔积脓的诊断标志物，但基线和系列CRP测量的预后价值尚未得到充分评估。本研究的目的是评估系列血清CRP水平测量与脓胸患者死亡风险之间的关联。
本数据库研究使用真实世界数据（RWD）数据库进行。纳入年龄≥40岁、入院时或次日接受胸廓切开术（胸腔置管）的胸腔积脓患者。排除标准为协变量缺失、24小时内死亡或24小时内转至其他医院。将基线和系列CRP水平作为暴露因素进行评估。主要结局是入院后90天内的死亡时间。采用多变量Cox比例风险模型评估基线CRP水平与死亡之间的关联。由于CRP测量的时间取决于每位患者的临床病程，因此应用联合回归模型评估每位患者的系列血清CRP测量值与死亡情况。联合回归模型将暴露因素的纵向数据分析与结局的生存分析相结合。我们同时使用线性混合效应模型估计系列CRP水平的潜在轨迹，并使用相对风险模型估计系列CRP测量值与死亡之间的关联，并对具有临床意义的混杂因素进行调整。
我们纳入了823例患者进行分析。其中，82例（10%）死亡，85例（10%）接受了胸外科手术。入院90天后，430例患者（52%）被截尾。基线CRP水平的对数与死亡风险无关（风险比：0.84[95%置信区间，0.59 - 1.20]），而血清CRP水平的累积对数越高，随着时间推移死亡风险越高（风险比：2.08[95%置信区间，3.28 - 5.18]）。
基线血清CRP水平与死亡风险无关，而血清CRP水平的系列上升趋势与死亡风险增加密切相关。医生可将系列血清CRP水平视为监测胸腔积脓患者治疗反应的生物标志物。
在线版本包含可在10.1186/s12890 - 025 - 03799 - 3获取的补充材料。
