Tuberc Respir Dis.  2007 Jul;63(1):24-30. 10.4046/trd.2007.63.1.24.

Treatment Results and Prognostic Factors of Complicated Parapneumonic Effusion and Empyema

Affiliations
  • 1Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea. sicha@knu.ac.kr

Abstract

BACKGROUND: Pleural effusion develops in approximately 40% of pneumonia patients. In 5-10% of these cases, it progresses to complicated parapneumonic effusion (CPPE) or empyema that requires drainage. The prognostic factors of CPPE and empyema remain to be clarified. We examined the treatment outcomes of CPPE and empyema and elucidating their prognostic factors.
METHODS
One hundred and fifteen patients with CPPE or empyema, who were diagnosed and treated in Kyungpook National University Hospital (Daegu, Korea) between September 2001 and December 2005, were retrospectively analyzed. All the data was acquired from their chart review, and regarding treatment results, the time to defervescence and the length of hospital stay were analyzed.
RESULTS
The treatment was successful in 101 patients with a success rate of 87.8%. Multivariate analysis showed the level of pleural fluid lactate dehydrogenase (LDH) to be a significant prognostic factor (odds ratio [OR] 7.37; 95% confidence interval [CI], 1.63 to 33.37; p=0.009). Pussy pleural fluid (r=0.236; p=0.01) and the frequency of urokinase use (r=0.257; p=0.01) correlated with the time to defervescence. However, there was no clinical factor that correlated with the length of hospital stay.
CONCLUSION
The pleural fluid LDH level is a useful prognostic factor for monitoring treatment results of CPPE and empyema.

Keyword

Empyema; Lactate dehydrogenase; Pleural effusion; Pneumonia; Prognosis

MeSH Terms

Drainage
Empyema*
Gyeongsangbuk-do
Humans
L-Lactate Dehydrogenase
Length of Stay
Multivariate Analysis
Pleural Effusion
Pneumonia
Prognosis
Retrospective Studies
Urokinase-Type Plasminogen Activator
L-Lactate Dehydrogenase
Urokinase-Type Plasminogen Activator

Reference

1. Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc. 2006. 3:75–80.
2. Hasley PB, Albaum MN, Li Y-H, Fuhrman CR, Britton CA, Marrie TJ, et al. Do pulmonary radiographic findings at presentation predict mortality in patients with community-acquired pneumonia? Arch Intern Med. 1996. 156:2206–2212.
3. Andrews NC, Parker EF, Shaww RR, Wilson NJ, Webb WR. Management of nontuberculous empyema: a statement of the subcommittee on surgery. Am Rev Respir Dis. 1962. 85:935–936.
4. Hamm H, Light RW. Parapneumonic effusion and empyema. Eur Respir J. 1997. 10:1150–1156.
5. Ozkan OS, Ozmen MN, Akhan O. Percutaneous management of parapneumonic effusions. Eur J Radiol. 2005. 55:311–320.
6. Kelly JW, Morris MJ. Empyema thoracis: medical aspects of evaluation and treatment. South Med J. 1994. 87:1103–1110.
7. Davies CW, Kearney SE, Gleeson FV, Davies RJ. Prediction of outcome and long-term survival in patients with pleural infection. Am J Respir Crit Care Med. 1999. 160:1682–1687.
8. Soriano T, Alegre J, Aleman C, Ruiz E, Vazquez A, Carrasco JL, et al. Factors influencing length of hospital stay in patients with bacterial pleural effusion. Respiration. 2005. 72:587–593.
9. Jimenez Castro D, Diaz G, Perez-Rodriguez E, Light RW. Prognostic features of residual pleural thickening in parapneumonic pleural effusions. Eur Respir J. 2003. 21:952–955.
10. Kim YS, Kim SM, Kim JH, Lee KS, Yang SC, Yoon HJ, et al. The effect of percutaneous pig-tail catheter drainage in the management of lung abscess and empyema. Tuberc Respir Dis. 1996. 43:571–578.
11. Chang JH. The evaluation of image-guided catheter drainage in pleural effusion and empyema. Tuberc Respir Dis. 1996. 43:403–409.
12. Park JW, You SM, Seol WJ, Paik EK, Lee KH, Seo JB, et al. Efficacy of pigtail catheter drainage in patients with thoracic empyema or complicated parapneumonic effusion. Tuberc Respir Dis. 2003. 54:219–229.
13. Helping patients who drink too much. A clinician's guide. 2005 ed. National Institute on Alcohol Abuse and Alcoholism. 2006. Retrieved 28 December. from http://pubs.niaaa.nih.gov/publications/practitioner/cliniciansguide2005/clinicians_guide.htm .
14. Dawson DA, Grant BF, Li TK. Quantifying the risks associated with exceeding recommended drinking limits. Alcohol Clin Exp Res. 2005. 29:902–908.
15. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score(SAPS II) based on European/North American multicenter study. JAMA. 1993. 270:2957–2963.
16. Lemmer JH, Botham MJ, Orringer MB. Modern management of adult thoracic empyema. J Thorac Cardiovasc Surg. 1985. 90:849–855.
17. Huang HC, Chang HY, Chen CW, Lee CH, Hsiue TR. Predicting factors for outcome of tube thoracostomy in complicated parapneumonic effusion or empyema. Chest. 1999. 115:751–756.
18. Diacon AH, Theron J, Schuurmans MM, Van de Wal BW, Bollinger CT. Intrapleural streptokinase for empyema and complicated parapneumonic effusions. Am J Respir Crit Care Med. 2004. 170:49–53.
19. Jensen EJ, Dahl R, Steffensen F. Bronchial reactivity to cigarette smoke: relation to lung function, respiratory symptoms, serum-immunoglobulin E and blood eosinophil and leukocyte counts. Respir Med. 2000. 94:119–127.
20. Mallampalli A, Guntupalli KK. Smoking and systemic disease. Clin Occup Environ Med. 2006. 5:173–192.
21. Froon AH, Bonten MJ, Gaillard CA, Greve JW, Dentener MA, de Leeuw PW, et al. Prediction of clinical severity and outcome of ventilator-associated pneumonia. Comparison of simplified acute physiology score with systemic inflammatory mediators. Am J Respir Crit Care Med. 1998. 158:1026–1031.
22. Aegerter P, Boumendil A, Retbi A, Minvielle E, Dervaux B, Guidet B. SAPS II revisited. Intensive Care Med. 2005. 31:416–423.
23. Marra AR, Bearman GM, Wenzel RP, Edmond MB. Comparison of severity of illness scoring systems for patients with nosocomial blood stream infection due to Pseudomonas aerusinosa. BMC Infect Dis. 2006. 6:132.
24. Sikka P, Jaafar WM, Bozkanat E, El-solh AA. A comparison of severity of illness scoring systems for elderly patients with severe pneumonia. Intensive Care Med. 2000. 26:1803–1810.
25. Misthos P, Sepsas E, Konstantinou M, Athanassiadi K, Skottis I, Lioulias A. Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study. Eur J Cardiothorac Surg. 2005. 28:599–603.
26. Bouros D, Schiza S, Patsourakis G, Chalkiadakis G, Panagou P, Siafakas NM. Intrapleural streptokinase versus urokinase in the treatment of complicated parapneumonic effusions: a prospective, double-blind study. Am J Respir Crit Care Med. 1997. 155:291–295.
27. Bouros D, Schiza S, Tzanakis N, Drositis J, Siafakas N. Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema. Eur Respir J. 1996. 9:1656–1659.
Full Text Links
  • TRD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr