Comparison of Procalcitonin, C-reactive Protein, and Interleukin-6 in the Postoperative Course After Lung Decortication Surgery: A Prospective Observational Study

Introduction Lung decortication is a surgical intervention performed to remove the fibrous pleural layer in conditions like pleural empyema or chronic pleuritis. Despite its therapeutic benefits, the postoperative period poses a high risk for complications such as infections and sepsis, which can significantly affect recovery. Biomarkers such as interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin (PCT) are increasingly employed to aid early detection of such complications. Objectives To evaluate and compare the roles of IL-6, CRP, and PCT in detecting postoperative sepsis in patients undergoing lung decortication and to determine their clinical utility in guiding early management decisions. Methods This observational study was conducted in the Departments of Anaesthesiology and General Surgery, King George's Medical University, Lucknow. A total of 112 patients aged 18-65 years with clinically proven pleural empyema undergoing elective lung decortication were enrolled. Patients on preoperative anti-inflammatory or immunosuppressive drugs were excluded. Preoperatively and on postoperative days 1, 3, and 5, biomarkers were analyzed. Data analysis was performed using SPSS 26.0 (IBM Corp., Armonk, NY, US), applying t-tests, chi-square tests, and analysis of variance (ANOVA) with a significance threshold of p<0.05. Results Of 112 patients, 44 (39.3%) developed sepsis. Septic patients were older (mean age 40.84±14.08 years) than non-septic patients (mean age 28.09±8.00 years). PCT levels were significantly higher in septic patients across all time points (p<0.001), declining over time postoperatively. CRP levels were significantly elevated in septic patients on days 3 and 5. IL-6 and CRP showed limited but supportive diagnostic value. Mortality was higher in the septic group (6.8%), though not statistically significant. Conclusion Procalcitonin is the most reliable biomarker for the early detection and monitoring of postoperative sepsis following lung decortication. Combining PCT with CRP and IL-6 enhances diagnostic accuracy and informs timely therapeutic interventions.