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Percutaneous transthoracic catheter drainage for lung abscess: a systematic review and meta-analysis

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Abstract

Objectives

To evaluate the outcomes of patients receiving image-guided percutaneous catheter drainage (PCD) for lung abscesses in terms of treatment success, major complications, and mortality as well as the predictors of those outcomes.

Methods

Embase and OVID-MEDLINE databases were searched to identify studies on lung abscesses treated with PCD that had extractable outcomes. The outcomes were pooled using a random-intercept logistic regression model. Multivariate Firth’s bias-reduced penalised-likelihood logistic regression analyses were performed to identify predictors of treatment success and complications. Methodological quality was assessed by summing scores of binary responses to items regarding selection, ascertainment of exposure and outcome, causality of follow-up duration, and reporting.

Results

From 26 studies with acceptable methodological quality (median score, 4; range, 3–5), 194 patients were included. The pooled rates of treatment success and major complications were 86.5% (95% confidence interval [CI], 78.5–91.8%; I2 = 23%) and 8.1% (95% CI, 4.1–15.3%; I2 = 26%), respectively. Four patients eventually died from uncontrolled lung abscesses (pooled rate, 1.5%; 95% CI, 0.2–11.1%; I2 = 36%). Malignancy-related abscess (odds ratio [OR], 0.129; 95% CI, 0.024–0.724; p = .022) and the occurrence of a major complication (OR, 0.065; 95% CI, 0.02–0.193; p < .001) were significant predictors of treatment failure. Traversing normal lung parenchyma was the only significant risk factor for major complications (OR, 27.69; 95% CI, 7.196–123.603; p < .001).

Conclusion

PCD under imaging guidance was effective for lung abscess treatment, with a low complication rate. Traversal of normal lung parenchyma was the sole risk factor for complications, and malignancy-related abscesses and the occurrence of major complications were predictors of treatment failure.

Key Points

• The pooled treatment success rate of PCD for lung abscess was reasonably high (86.5%); malignancy-related abscesses and the occurrence of a major complication were predictors of treatment failure.

• The pooled rate of percutaneous transthoracic catheter drainage-related major complications was 8.1% and traversing normal lung parenchyma by the catheter was the only risk factor.

• The pooled mortality rate from uncontrolled lung abscesses with percutaneous transthoracic catheter drainage was low.

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Abbreviations

BPF:

Bronchopleural fistula

CI:

Confidence interval

PCD:

Percutaneous transthoracic catheter drainage

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

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Acknowledgements

There are no acknowledgements for this article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, 03080, Korea

    Jong Hyuk Lee & Chang Min Park

  2. Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea

    Hyunsook Hong

  3. Pulmonology Unit, General Hospital of Pordenone, Pordenone, Italy

    Mario Tamburrini

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  1. Jong Hyuk Lee
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  2. Hyunsook Hong
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  3. Mario Tamburrini
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  4. Chang Min Park
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Correspondence to Chang Min Park.

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The scientific guarantor of this publication is Chang Min Park.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise (Hyunsook Hong, Ph.D.; Medical Research Collaborating Center)

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Written informed consent was not required because this study is systematic review and meta-analysis.

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Institutional Review Board approval was not required because this study is systematic review and meta-analysis.

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This study is systematic review of the literature and meta-analysis of all their patients.

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Lee, J.H., Hong, H., Tamburrini, M. et al. Percutaneous transthoracic catheter drainage for lung abscess: a systematic review and meta-analysis. Eur Radiol 32, 1184–1194 (2022). https://doi.org/10.1007/s00330-021-08149-5

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  • DOI: https://doi.org/10.1007/s00330-021-08149-5

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