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An independent prognostic factor in surgical cases of pleural empyema caused by common bacteria is the presence of a fistula

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Abstract

Objectives

Some surgical cases of pleural empyema lead to death despite multidisciplinary treatment. The purpose of this study was to identify prognostic factors in cases treated surgically for pneumonia-associated pleural effusions and empyema caused by common bacteria.

Methods

We conducted a retrospective cohort study of 108 surgical patients of empyema who encountered at our hospital between 2011 and 2021. Patients were divided into surviving and non-surviving cases. Factors on admission (age, sex, body mass index, presence of fistula, performance status, pleural fluid culture results, HbA1c, albumin, leukocytes, hemoglobin, body temperature, heart rate, respiratory rate, systolic blood pressure, prognostic nutritional index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and RAPID score) were compared between the two groups.

Results

There were 87 cases of pleural empyema caused by pneumonia due to common bacteria. Variables that differed significantly in univariate analysis between the surviving and non-surviving cases in patients’ characteristics on admission were fistula (p value < 0.001, odds ratio 20.000, 95% confidence interval 3.478–115.022), positive pleural fluid culture (0.016, 6.591, 1.190–36.502), body mass index < 18.5 (0.001, 16.857, 1.915–148.349), performance status 0–1 (0.007, 11.778, 1.349–102.858), and hemoglobin (0.024, 1.768, 1.077–2.904). Multivariate analysis showed significant differences in the presence of fistula (p = 0.036, CI 1.174–125.825). The odds ratio was 12.154. The mortality rate was 3.8% for non-fistulous empyema and 44.4% for fistulous empyema. In 6 of 9 cases of fistulous empyema, the fistula could be closed.

Conclusion

Fistula was a significant independent prognostic factor for pneumonia-associated pleural effusions and empyema caused by common bacteria.

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References

  1. Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc. 2006;3:75–80.

    Article  CAS  PubMed  Google Scholar 

  2. Ferguson AD, Prescott RJ, Selkon JB, Watson D, Swinburn CR. The clinical course and management of thoracic empyema. QJM. 1996;89:285–9.

    Article  CAS  PubMed  Google Scholar 

  3. Bedawi EO, Hassan M, Rahman NM. Recent developments in the management of pleural infection: a comprehensive review. Clin Respir J. 2018;12:2309–20.

    Article  PubMed  Google Scholar 

  4. Light RW. A new classification of parapneumonic effusions and empyema. Chest. 1995;108:299–301.

    Article  CAS  PubMed  Google Scholar 

  5. Hu Y, Shen J, Liu R, Feng Z, Zhang C, Ling L, et al. Prognostic value of pretreatment prognostic nutritional index in non-small cell lung cancer: a systematic review and meta-analysis. Int J Biol Markers. 2018;33:372–8.

    Article  CAS  PubMed  Google Scholar 

  6. Lee SI, Ko KP, Choi CH, Park CH, Park KY, Son KH. Does the prognostic nutritional index have a predictive role in the outcomes of adult cardiac surgery? J Thorac Cardiovasc Surg. 2020;160(145–53): e3.

    Google Scholar 

  7. Tsukioka T, Izumi N, Mizuguchi S, Kyukwang C, Komatsu H, Toda M, et al. Positive correlation between sarcopenia and elevation of neutrophil/lymphocyte ratio in pathological stage IIIA (N2-positive) non-small cell lung cancer patients. Gen Thorac Cardiovasc Surg. 2018;66:716–22.

    Article  PubMed  Google Scholar 

  8. Nakao M, Muramatsu H, Arakawa S, Sakai Y, Suzuki Y, Fujita K, et al. Immunonutritional status and pulmonary cavitation in patients with tuberculosis: a revisit with an assessment of neutrophil/lymphocyte ratio. Respir Investig. 2019;57:60–6.

    Article  PubMed  Google Scholar 

  9. Rahman NM, Kahan BC, Miller RF, Gleeson FV, Nunn AJ, Maskell NA. A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. Chest. 2014;145:848–55.

    Article  PubMed  Google Scholar 

  10. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol. 1982;5:649–55.

    Article  CAS  PubMed  Google Scholar 

  11. Bobbio A, Bouam S, Frenkiel J, Zarca K, Fournel L, Canny E, et al. Epidemiology and prognostic factors of pleural empyema. Thorax. 2021;76:1117–23.

    Article  PubMed  Google Scholar 

  12. Towe CW, Carr SR, Donahue JM, Burrows WM, Perry Y, Kim S, et al. Morbidity and 30-day mortality after decortication for parapneumonic empyema and pleural effusion among patients in the Society of Thoracic Surgeons’ General Thoracic Surgery Database. J Thorac Cardiovasc Surg. 2019;157(1288–97): e4.

    Google Scholar 

  13. Reichert M, Posentrup B, Hecker A, Schneck E, Pons-Kuhnemann J, Augustin F, et al. Thoracotomy versus video-assisted thoracoscopic surgery (VATS) in stage III empyema-an analysis of 217 consecutive patients. Surg Endosc. 2018;32:2664–75.

    Article  PubMed  Google Scholar 

  14. Lin CW, Huang KY, Lin CH, Wang BY, Kor CT, Hou MH, et al. Video-assisted thoracoscopic surgery in community-acquired thoracic empyema: analysis of risk factors for mortality. Surg Infect (Larchmt). 2022;23:191–8.

    Article  PubMed  Google Scholar 

  15. Semenkovich TR, Olsen MA, Puri V, Meyers BF, Kozower BD. Current state of empyema management. Ann Thorac Surg. 2018;105:1589–96.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shen KR, Bribriesco A, Crabtree T, Denlinger C, Eby J, Eiken P, et al. The American association for thoracic surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg. 2017;153:e129–46.

    Article  PubMed  Google Scholar 

  17. Fricke A, Bannasch H, Klein HF, Wiesemann S, Samson-Himmelstjerna P, Passlick B, et al. Pedicled and free flaps for intrathoracic fistula management. Eur J Cardiothorac Surg. 2017;52:1211–7.

    PubMed  Google Scholar 

  18. Jiang F, Huang J, You Q, Yuan F, Yin R, Xu L. Surgical treatment for bronchopleural fistula with omentum covering after pulmonary resection for non-small cell lung cancer. Thorac Cancer. 2013;4:249–53.

    Article  PubMed  Google Scholar 

  19. Bille A, Sabarwhal T, Tom R. Vascular occlusion device closure of bronchial stump fistulae: a straightforward approach to manage bronchial stump breakdown. Gen Thorac Cardiovasc Surg. 2012;60:847–50.

    Article  PubMed  Google Scholar 

  20. Lois M, Noppen M. Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest. 2005;128:3955–65.

    Article  PubMed  Google Scholar 

  21. Ando T, Kawashima M, Matsui H, Takeda K, Sato R, Ohshima N, et al. Clinical features and prognosis of nontuberculous mycobacterial pleuritis. Respiration. 2018;96:507–13.

    Article  CAS  PubMed  Google Scholar 

  22. Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet. 2019;393:2636–46.

    Article  PubMed  Google Scholar 

  23. Wakabayashi H. Rehabilitation nutrition in general and family medicine. J Gen Fam Med. 2017;18:153–4.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Makizako H, Shimada H, Doi T, Tsutsumimoto K, Hotta R, Nakakubo S, et al. (2018) Social frailty leads to the development of physical frailty among physically non-frail adults: a four-year follow-up longitudinal cohort study. Int J Environ Res Public Health. 15.

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Authors and Affiliations

  1. Department of General Thoracic Surgery, National Hospital Organization, Kanagawa National Hospital, 666-1 Ochiai Hadano, Kanagawa, 257-8585, Japan

    Yasoo Sugiura, Hiroyuki Fujimoto & Toshinori Hashizume

  2. Department of Respiratory Medicine, National Hospital Organization, Kanagawa National Hospital, Kanagawa, Japan

    Morio Nakamura, Yasuyuki Ohkubo, Hisae Fusegawa, Osamu Kawai & Norito Araki

  3. Department of Plastic and Reconstructive Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

    Hiroko Ochiai

Authors
  1. Yasoo Sugiura
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  2. Morio Nakamura
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  3. Hiroyuki Fujimoto
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  4. Hiroko Ochiai
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  5. Yasuyuki Ohkubo
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  6. Hisae Fusegawa
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  7. Osamu Kawai
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  9. Toshinori Hashizume
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Correspondence to Yasoo Sugiura.

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Sugiura, Y., Nakamura, M., Fujimoto, H. et al. An independent prognostic factor in surgical cases of pleural empyema caused by common bacteria is the presence of a fistula. Gen Thorac Cardiovasc Surg 71, 657–664 (2023). https://doi.org/10.1007/s11748-023-01933-8

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  • DOI: https://doi.org/10.1007/s11748-023-01933-8

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