Korean J Intern Med.  2014 Sep;29(5):603-612. 10.3904/kjim.2014.29.5.603.

Factors predictive of the failure of medical treatment in patients with pleural infection

• Kim SK
• Kang CU
• Song SH
• Cho DG
• Cho KD
• Kim CH

• KMID: 1794625
• DOI: http://doi.org/10.3904/kjim.2014.29.5.603

Abstract

BACKGROUND/AIMS
The clinical outcomes of some patients with pleural infection may be favorable with medical treatment alone, but in others, the disease progresses and requires additional surgical treatment. However, little is known about the factors affecting this difference. The aim of this study was to investigate the factors predictive of failure of medical treatment in patients with pleural infection.
METHODS
A cohort of 127 consecutive patients who were admitted to the hospital with pleural infection was studied. Clinical manifestations and laboratory findings in patients in whom medical treatment succeeded or failed were reviewed.
RESULTS
In univariate analysis, the significant factors associated with medical treatment outcome were age, smoking history, duration of chief complaint, serum albumin level, and pleural fluid glucose and lactate dehydrogenase levels (p < 0.05). Multivariate logistic regression analysis identified age and duration of chief complaint as independent predictive factors for failure of medical treatment, with odds ratios of 0.871 (p = 0.013) and 0.797 (p = 0.026), respectively. Receiver operating characteristic curve analysis determined cutoff values of 50.5 years for age and 4.5 days for duration of chief complaint.
CONCLUSIONS
We demonstrated that a younger age < 50.5 years and shorter duration of chief complaint < 4.5 days were independent predictive factors for the failure of medical treatment in patients with pleural infection. This suggests their role as evaluative criteria in setting indications for the optimal treatment in patients with pleural infection. A larger, prospective study is required to confirm these findings.

Keyword

Empyema, pleural; Drainage; Fibrinolytic agents; Treatment outcome

MeSH Terms

Adult
Aged
Anti-Bacterial Agents/therapeutic use
Cohort Studies
Drainage
Empyema, Pleural/metabolism/*therapy
Female
Glucose/metabolism
Humans
L-Lactate Dehydrogenase/metabolism
Male
Pleural Effusion/metabolism/*therapy
Serum Albumin/metabolism
Thoracic Surgery, Video-Assisted
Treatment Failure
Anti-Bacterial Agents
Glucose
L-Lactate Dehydrogenase
Serum Albumin