Background: The aim of this study was to identify key factors on admission predicting the development of complicated parapneumonic effusion or empyema in patients admitted with community-acquired pneumonia. Methods: A prospective observational study of patients admitted with community-acquired pneumonia in NHS Lothian, UK, was conducted. Multivariate regression analyses were used to evaluate factors that could predict the development of complicated parapneumonic effusion or empyema, including admission demographics, clinical features, laboratory tests and pneumonia-specific (Pneumonia Severity Index (PSI), CURB65 (New onset confusion, urea .7 mmol/l, Respiratory rate >30 breaths/min, Systolic blood pressure , 90 mm Hg and/or diastolic blood pressure #60 mm Hg and age >65 years) and CRB65 (New onset confusion, Respiratory rate >30 breaths/min, Systolic blood pressure ,90 mm Hg and/or diastolic blood pressure #60 mm Hg and age >65 years)) and generic sepsis scoring systems (APACHE II (Acute Physiology and Chronic Health Evaluation II), SEWS (standardised early warning score) and systemic inflammatory response syndrome (SIRS)). Results: 1269 patients were included in the study and 92 patients (7.2%) developed complicated parapneumonic effusion or empyema. The pneumonia-specific and generic sepsis scoring systems had no value in predicting complicated parapneumonic effusion or empyema. Multivariate logistic regression identified albumin ,30 g/l adjusted odds ratio (AOR) 4.55 (95% CI 2.45 to 8.45, p,0.0001), sodium ,130 mmol/l AOR 2.70 (1.55 to 4.70, p = 0.0005), platelet count .400610 9 /l AOR 4.09 (2.21 to 7.54, p,0.0001), C-reactive protein .100 mg/l AOR 15.7 (3.69 to 66.9, p,0.0001) and a history of alcohol abuse AOR 4.28 (1.87 to 9.82, p = 0.0006) or intravenous drug use AOR 2.82 (1.09 to 7.30, p = 0.03) as independently associated with development of complicated parapneumonic effusion or empyema. A history of chronic obstructive pulmonary disease was associated with decreased risk, AOR 0.18 (0.06 to 0.53, p = 0.002). A 6-point scoring system using these combined variables had good discriminatory value: area under the receiver operator characteristic curve (AUC) 0.84 (95% CI 0.81 to 0.86, p,0.0001). Conclusion: This study has identified seven clinical factors predicting the development of complicated parapneumonic effusion or empyema. Independent validation is needed.Complicated parapneumonic effusions and empyema are key complications of communityacquired pneumonia necessitating prolonged treatment, intercostal drainage and frequently surgical management, leading to prolonged hospital stay.

Of the 79 patients admitted for PD, 51% became colonized with MRSA infection. Systemic hospital-acquired MRSA infection in 33% was associated with prolonged postoperative stay, increased wound and chest infections, and increased risk of postoperative hemorrhage.

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Introduction and ObjectivesObstructive sleep apnoea (OSA) is often undiagnosed and hence untreated. Its prevalence is ever increasing given the escalating obesity of the population. Apnoea/hypopnoea index (AHI) is commonly used to diagnose and classify the severity of OSA. The overnight oximetry, which measures oxygen desaturation index (ODI), is far simpler to measure than a full respiratory polysomnography, but its diagnostic accuracy at predicting OSA has not been formally established. We proposed that in patients with morbid obesity (BMI ≥40), the diagnostic accuracy for establishing an OSA diagnosis using ODI is as effective as AHI.MethodsThe data from the respiratory polysomnography of those individuals with a BMI greater than 40 kg/m2, who were referred between January to December 2015 to the sleep service at St Peter’s Hospital, were reviewed and measures of AHI and ODI were compared.Results79 individuals with a BMI greater than 40 who underwent respiratory polysomnography were identified.Mean age 52 (Age range 21–78)Mean BMI 47.4 (BMI range 40–66.2)Mean AHI 36 (AHI range 2.7–112.1)Mean ODI 36.6 (ODI range 3–105.5)For BMI’s≥40, ODI is as effective as AHI in diagnosing OSA with a strong positive correlation (R2=0.955). For those at the more severe end of the spectrum, the correlation is deeper.Abstract P62 Table 1Positive correlation for AHI and ODI at BMI>40DiscussionThe data provided by a respiratory polysomnography test provides a range of parameters, but polysomnography is resource intensive and requires significant time and expertise to assess properly. SIGN guidance states that oximetry can positively diagnose OSA but cannot exclude it.1 There are multiple benefits to having a simple tool that can identify high-risk individuals that may suffer with OSA including early diagnosis and reduced cost as well as resource utilisation. This is likely to improve patient care with earlier diagnosis and treatment of OSA. Overnight oximetry can safely diagnose OSA in morbidly obese patients. This has the potential to optimise efficiency and reduce cost without impacting patient care.ReferencesChung F, Liao P, Elsaid H, Islam S, Shapiro CM, Sun Y. Oxygen desaturation index from nocturnal oximetry: A sensitive and specific tool to detect sleep-disordered breathing in surgical patients. Anesth Analg2012;114(5):993–1000.SIGN. Management of obstructive sleep apnoea/hypopnoea syndrome in adults: a national clinical guideline. Scottish Intercollegiate Guidelines Network2003.

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