Pleural Empyema and Aortic Aneurysm

Abstract

Pleural empyema (PE) may evolve into necrosis, fistula in the thorax, and sepsis; thus, it is also associated with high mortality.We investigated and analyzed the risk of aortic aneurysm (AA) in a cohort study of patients with PE.A total of 34,250 patients diagnosed with PE were identified as the PE cohort, and 137,000 patients without PE were selected randomly as the control group and matched by sex, age, and index year of PE diagnosis. Patients ages 20 years and younger with a history of AA were excluded. The risk of AA was analyzed using a Cox proportional hazards regression model.Excess risk of AA development was 1.69-fold higher in PE patients (adjusted hazard ratio [aHR] = 1.69; 95% confidence interval [CI] = 1.39–2.05) compared with non-PE patients. The patients with PE exhibited a greater adjusted risk of AA (aHR = 2.01; CI = 1.44–2.81) even if they did not have any of the 9 comorbidities included in our analysis (diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, heart failure, cardiac artery disease, stroke, bacterial endocarditis, and rheumatic endocarditis). Compared with the patients without any of the 9 comorbidities or PE, the patients with only PE had a greater risk of developing AA (aHR = 2.00; CI = 1.43–2.79). The PE cohort had a significantly higher cumulative incidence of AA than the non-PE cohort did during 12 years of follow-up.In a large-scale cohort, patients with PE are linked with an increased risk of AA.

A systematic review of comorbidities and outcomes of adult patients with pleural infection

“…We found that the percentage prevalence of pre-existing comorbidity was high (median 72%) with a wide range of chronic conditions affecting the major organ systems. This is consistent with large population-based studies, which have reported comorbidity prevalence of up to 74% [5] and supports the hypothesis that the rise in the incidence of pleural infection in recent years might be associated with an increasingly ageing, multi-morbid population.…”

“…This is supported by data from large population-based cohorts demonstrating that incidence is skewed towards older persons and is rising more quickly in this group [2, 6]. Furthermore, rates of comorbidity in pleural infection have been reported as being as high as 74% [2, 5], and patients with increased pre-existing comorbidity have higher mortality rates (20.6% if Charlton comorbidity score (CCS) >2 points, 6% if CCS 0 points) [2].…”

“…Pleural infection is common, with >30 000 diagnoses in the years 2000–2011 in the largest and most recent population-based cohort in Taiwan [5]. In recent years, incidence rates have been trending upwards [2, 3, 6], and coupled with advancing therapeutic techniques, the management of pleural infection represents a growing resource strain, with reported median length of hospital stay in a Canadian study averaging nearly 22 days [6].…”

Age-adjusted Charlson comorbidity score is associated with the risk of empyema in patients with COPD

“…[1] In a previous study, empyema was associated with an increased risk of aortic aneurysm after adjusting for age, sex, and the comorbidities of diabetes, hypertension, hyperlipidemia, COPD, heart failure, coronary artery disease, stroke, bacterial endocarditis, and rheumatic endocarditis. [2] COPD can lead to the impairment of pulmonary defense and an increased risk of pneumonia. [3] Empyema is a complication of pneumonia in which pus and fluid from infected lung tissue collect in the pleural cavity, although empyema may arise from other infections as well.…”

Surgical and nonsurgical outcomes for treating a cohort of empyema thoracis patients: A monocenteric retrospective cohort study

“…Although, all of the existing studies were based on single treatment procedure without any comparisons (i.e., surgical or nonsurgical) and hence, their results could not be reliable for choosing the best one. There are several cohort studies carried out on empyema [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] from which only two of them were retrospective [14] , [17] and they were analyzing the risk of aortic aneurysm [14] as well as the characteristics of medically and surgically treated patients in terms of chest pain, IV antibiotics, chest tube, and intrapleural fibrinolytics [17] . A retrospective cohort study is used for comparing medical treated groups for whom the information for the outcomes are recorded in a long period of time to be analyzed later in the near future [18] .…”