Predicting Complicated Parapneumonic Effusion in Community Acquired Pneumonia: Hospital Based Case-Control Study
- 52 Downloads
To identify predictors of complicated parapneumonic effusion (CPE)/empyema in patients of community acquired pneumonia (CAP) by using clinical and simple laboratory variables like hemoglobin (Hb), serum C-reactive protein (CRP), serum albumin (SA) levels and total leukocyte counts (TLC).
This prospective case-control study was conducted after institutional ethical approval. Subjects between ages of 2–59 mo with World Health Organization (WHO) defined CAP with written, informed parental consent were included. Cases had CAP with CPE/empyema diagnosed by pleurocentesis. Controls had severe CAP without significant pleural collection on chest X-ray (CXR). Patients with congenital and chronic diseases/infections and possible immune deficiency were excluded. Variables with univariate association with case-control status were considered as potential predictors. Final prediction model was developed by Forward Stepwise Logistic Regression (FSLR). Adjusted odd’s ratios (Adj OR) were smoothened into nearest whole numbers to develop KGMU-CPE score.
From 2016 to 17, 30 cases (66.6% males, age 38.7 + 14.9 mo) and 118 controls (78% males, age 17.8 + 16.9 mo) were included. In FSLR, predictors of CPE/empyema were ibuprofen intake (adj OR 6.8; 95%CI: 1.07–43.6), infective focus elsewhere (adj OR 28.2; 95%CI: 1.4–563.1), hypoalbuminemia <3.1 g/dL (adj OR 6.9; 95%CI: 1.22–39.3), serum CRP >20 mg/dL (adj OR 59; 95%CI: 1.86–1874.7), Hb <10 g/dL (adj OR 21.1; 95%CI: 2.8–158.1) and TLC >10,000 (adj OR 37; 95%CI: 5.7–239.8) and these six variables formed KGMU-CPE Score with a minimum score of 0 and maximum of 25. KGMU-CPE score area under the ROC curve was 0.97 and cut- off 15.55 had sensitivity of 80% and specificity of 94% for predicting CPE/empyema.
Using simple clinical and laboratory parameters it is possible to predict CAP with CPE/empyema. Use of ibuprofen is to be avoided in CAP as it associated with CPE. KGMU-CPE score had good diagnostic accuracy and needs external validation.
KeywordsCommunity acquired pneumonia Children Complicated parapneumonic effusion Empyema Predictors KGMP-CPE score
SA: Conceptualization. Both authors are responsible for data collection, analysis and writing the manuscript. This was MD thesis work of Meganathan P. SA will act as guarantor for this paper.
Compliance with Ethical Standards
Conflict of Interest
- 1.World Health Organization (WHO) Pneumonia Fact Sheet. Updated September 2016, Available at: http://www.who.int/mediacentre/factsheets/fs331/en/. Accessed on 26th June 2018.
- 3.Maziah W, Choo KE, Ray JG, Ariffin WW. Empyema thoracis in hospitalized children in Kelantan, Malaysia. J Trop Pediatr. 1995;41:185–8.Google Scholar
- 6.Anstadt MP, Guill CK, Ferguson ER, et al. Surgical versus nonsurgical treatment of empyema thoracis: an outcomes analysis. Am J Med Sci. 2003;326:9–14.Google Scholar
- 7.Dass R, Deka NM, Barman H, et al. Empyema thoracis: analysis of 150 cases from a tertiary care Centre in north East India. Indian J Pediatr. 2011;78:1371–7.Google Scholar
- 10.World Health Organization. Revised WHO classification and treatment of pneumonia in children at health facilities: evidence summaries. Available at: http://apps.who.int/iris/bitstream/10665/137319/1/9789241507813_eng.pdf. Accessed on 26th June 2018.
- 12.FAO, WHO. World Declaration and Plan of Action for Nutrition. International Conference on Nutrition. Rome, Food and Agriculture Organization of the United Nations, December 1992. Available at: http://whqlibdoc.who.int/hq/1992/a34303.pdf. Accessed on 26th June 2018.
- 15.World Health Organization. Standardization of interpretation of chest radiographs for the diagnosis of pneumonia in children. Available at: http://apps.who.int/iris/bitstream/10665/66956/1/WHO_V_and_B_01.35.pdf. Accessed on 26th June 2018.
- 16.WHO Multicentre Growth Reference Study Group. WHO child growth standards: length/ height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: World Health Organization; 2006.Google Scholar
- 17.Prober CG, Srinivas NS, Mathew R. Central nervous system infections. In: Kleigman, Staton, St Geme, et al editors. Nelson Text book of Pediatrics, 20th ed. Philadelphia: Elsevier; 2016. p. 2936–46.Google Scholar
- 18.Raosoft Sample size Calculator. Available at: http://www.raosoft.com/samplesize.html. Accessed on 2nd August 2016.
- 19.Colice GL, Curtis A, Deslauriers J, et al. Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline. Chest. 2000;118:1158–71.Google Scholar
- 22.Mazaleuskaya LL, Theken KN, Gong L, et al. PharmGKB summary: ibuprofen pathways. Pharmacogenet Genomics. 2015;25:96–106.Google Scholar
- 24.Solberg CO. Influence of phenylbutazone on the phagocytic and bactericidal activities of neutrophil granulocytes. Acta Pathol Microbiol Scand B: Microbiol Immunol. 1974;82:258–62.Google Scholar
- 25.Factor SH, Levine OS, Harrison LH, et al. Risk factors for pediatric invasive group a streptococcal disease. Emerg Infect Dis. 2005;11:1062–6.Google Scholar
- 26.Dilber E, Cakir M, Kalyoncu M, Okten A. C-reactive protein: a sensitive marker in the management of treatment response in parapneumonic empyema of children. Turkish J Pediatr. 2003;45:311–4.Google Scholar
- 29.Wexler ID, Knoll S, Picard E, et al. Clinical characteristics and outcome of complicated pneumococcal pneumonia in a pediatric population. Pediatr Pulmonol. 2006;41:726–34.Google Scholar
- 30.Kopec JA, Esdaile JM. Bias in case-control studies. A review. J Epidemiol Community Health. 1990;44:179–86.Google Scholar