Outcome and mortality analysis in complicated parapneumonic effusion and empyema

Abstract

Background: Pleural infection is a clinical problem with high mortality and morbidity; 20% of patients with empyema die and approximately 20% require surgery to recover within 12 months of their infection. Studies on pleural infection and their outcome are relevant in developing a scoring system by which failing cases and cases at risk of death can be identified. Methods:The study is retrospective analysis of patient cohort admitted to the tertiary care institute from the period of July 2014 to July 2016 to determine the prognostic factors in the outcome of pleural space infection. The study included all complex, complicated parapneumonic effusion and empyema including tuberculosis above the age of fifteen years. The primary end of the present study was the success or failure. Possible predicting factors for the success or failure of therapy were assessed against this end. Pearson chi square test, χ2 (Fisher's exact test when needed) test was used for discrete data. Logistic regression analysis was applied to adjust for confounding variables to assess the possible predicting factors. Survival plot and analysis using Kaplan Meier method was used. Results: 220 with parapneumonic effusion and empyema were analyzed. Successful outcome was seen in 107 and 113 had failed outcome. Mortality was 30.50%. By logistic regression method the odds of failed outcome were high with diabetes, hypoalbuminemia, loculation, tuberculosis which can predict the outcome especially complicated and complex parapneumonic effusion, empyema (p<0.05). Conclusions: Diabetes, hypoalbuminemia, loculation, tuberculosis should be used in the prediction scoring system. Arivudainambi VP. Int J Clin Trials. 2017 Nov;4(4):176-183 International Journal of Clinical Trials | October-December 2017 | Vol 4 | Issue 4 Page 177 operative intervention. Delay in instituting proper therapy for these effusions is responsible for some of the morbidity associated with parapneumonic effusions. 5 For a simple parapneumonic effusion antibiotics according to culture and sensitivity will suffice. In complicated parapneumonic effusion and empyema intervention in the form of thoracentesis, tube thoracostomy, thoracoscopic intervention, surgery will be needed accordingly. Studies on pleural infection and their outcome are relevant in developing a scoring system by which failing cases and cases at risk of death can be identified.Empyema thoracis (ET) or pyothorax is the inflammatory process of infection in pleural space causing the accumulation and organization of purulent material in the pleural space1; first reported by Hippocrates approximately 2400 years ago.6 According to the American Thoracic Society, the ET process can be divided into three phases: (1) exudative (acute or Stage I), where exudative fluid accumulates without loculation; (2) fibrinopurulent (Stage II), where pleural fluid becomes turbid or purulent with loculation; and (3) organizing (chronic or Stage III), where thickened pus or fibrin peels begin to form, and granulation tissue replacement...

Diagnosis Dan Penatalaksanan Empiema

“…Pasien empiema yang tidak ditangani dengan baik dapat mengakitbatkan kematian. Sekitar 20% pasien dengan empyema meninggal, dan 20% penderita lainnya membutuhkan operasi dan sembuh dalam 12 bulan akibat infeksi (Periasamy, 2017). Oleh karena itu, perlu untuk mengetahui mengenai empiema agar dapat mendeteksi kasus ini dengan baik dan menurunkan angka mortalitas pada pasien empiema.…”

Complicated Management of Left-Sided Loculated Empyema Secondary to Streptococcus intermedius and Prevotella in a 53-Year-Old Male

“…Across all three subtypes, morbidity and mortality rates are high, particularly among elderly and immunocompromised patients [3]. Mortality for patients with empyema reaches as high as 20%, and the need for eventual surgery is a similar 20% [4]. Most commonly, parapneumonic effusion is addressed through non-surgical management, but in rare cases, surgical intervention may be warranted [5,6].…”