Thoracoscopic treatment of pleural empyema in children: the importance of biomarkers in predicting outcomes

Introduction. Pleural empyema in children is a complex form of pathology. Despite the clinical successes, the tasks of individually assessing the severity of the course and predicting outcomes in children with pleural empyema remain relevant. In this regard, biomarkers reflecting the intensity of systemic inflammation and the course of convalescence in children are of particular importance. Quantitative analysis of changes in the content of these biologically active compounds makes it possible to identify patients with a high risk of complications, predict recovery course and optimize treatment tactics. Aim: to determine both the clinical efficacy of thoracoscopic treatment of pleural empyema in children and the importance of biomarkers in predicting clinical outcomes.
Materials and methods. There were examined 126 children aged 1 to 17 years with a diagnosis of acute pleural empyema who underwent inpatient treatment. The patients were divided into two groups: the main group consisted of 65 children (51.6%) who underwent video thoracoscopic intervention at an early stage, the comparison group included 61 patients (48.4%) who received treatment for pleural empyema without early thoracoscopy. The concentrations of biomarkers in the blood were determined in all patients: before surgery, 24 hours after the intervention, and on the 3rd day after surgery. Quantitative analysis of catecholamines (epinephrine, norepinephrine) was performed by high performance liquid chromatography (HPLC). The levels of cortisol, cytokines, lactate, C-reactive protein, and procalcitonin were determined by immunochemical methods. All the received data has been processed statistically.
Results. In children with pleural empyema, the blood levels of cortisol, adrenaline, and norepinephrine were significantly increased compared with the levels in the comparison group. The level of procalcitonin in the patients of the main group was increased by more than 3.5 times, which indicates the course of a severe bacterial infection. The blood concentrations of cytokines: interleukins-6, -10 and tumor necrosis factor in children with pleural empyema were also significantly increased, reflecting the course of the active inflammatory process. In patients of the main group, after performing an early video thoracoscopy, the detected lower increase in blood levels of inflammatory biomarkers indicates to effective recovery. Monitoring of changes in these biomarkers made it possible to optimize treatment and improve the prognosis of the disease.
Conclusion. The necessity of early thoracoscopic intervention and the use of biomarkers as significant criteria for optimizing the treatment of children with pleural empyema has been determined.
Contributions: Faiziev O.Ya. — concept and study design; Yusupov A.S., Akramova Kh.A., Faiziev Ya.N. — data collection and processing; Abzalova M.Y. — statistical analysis; Faiziev O.Ya. — writing the text; Yusupov A.S. — editing the text. All coauthors — approval of the final version of the article, responsibility for the integrity of all parts of the article.
Acknowledgments. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.

Received: January 16, 2026
Accepted: February 10, 2026
Published: February 27, 2026

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