Outcome and clinical characteristics in pleural empyema: a retrospective study

Pleural empyema is a serious condition with a considerable mortality rate and morbidity. This study evaluated the correlations between several potential prognostic factors (age, predisposing diseases, early drainage, insufficient initial antimicrobial therapy, thoracic surgical treatment, intrapleural fibrinolysis, and nosocomial status) and outcome.

Danish patients with positive pleural cultures attending 3 hospitals over a 9-y period, were identified in the laboratory databases. Clinical details and outcome were evaluated retrospectively by audit of the medical records.

We included 158 patients in this study. The overall mortality was 27% and the median length of stay was 29 days. Mortality correlated independently with several factors: nosocomial infection (odds ratio (OR) 2.62, 95% confidence interval (CI) 1.71-4.16), predisposing conditions (OR 2.17, 95% CI 1.50-3.14), and also with the possibly interventional factors of sufficient initial antimicrobial therapy (OR 0.45, 95% CI 0.31-0.65), thoracic surgery treatment (OR 0.27, 95% CI 0.14-0.52) and local fibrinolytic therapy (OR 0.13, 95% CI 0.06-0.28). Delay in chest tube drainage more than 2 days was not independently correlated with mortality. The initial biochemical diagnostics of non-purulent pleural effusions (63%) did not follow the current international guidelines.

Factors correlating independently with survival included the possible interventional parameters of fibrinolytic therapy, insufficient initial antimicrobial therapy, and having thoracic surgery treatment.