Clinical Risk Factors for Death in Patients With Empyema and Active Malignancy

Area of Science:

• Pulmonology
• Oncology
• Critical Care Medicine

Background:

• Pleural infection (empyema) presents a significant clinical challenge, particularly for patients with active malignancy.
• Management in this population is complex, balancing treatment needs, surgical tolerance, and prognosis.
• Identifying high-risk individuals is crucial for guiding clinical care and improving outcomes.

Purpose of the Study:

• To identify risk factors for mortality and need for surgery in patients with active malignancy and empyema.
• To develop predictive models for adverse outcomes in this vulnerable patient group.

Main Methods:

• Retrospective cohort study analyzing 202 patients with active malignancy and empyema.
• Utilized standard Cox regression and cause-specific hazard regression models.
• Primary outcome: time to death from empyema at three months; secondary outcome: surgery at 30 days.

Main Results:

• Overall three-month mortality rate was 32.7%.
• Multivariable analysis identified female gender and higher urea as significant risk factors for death (AUC=0.70).
• Risk factors for 30-day surgery included frank pus and postsurgical empyema (AUC=0.76).

Conclusions:

• Patients with active malignancy and empyema exhibit a substantial risk of mortality.
• Female gender and elevated urea are significant predictors of death from empyema.
• Predictive models can aid in risk stratification for these complex patients.