Empyema – Rokowania, prognozy i postęp choroby

Empyema
Rokowania, prognozy i postęp choroby

Ropniak opłucnej (empyema) jest poważnym stanem klinicznym, charakteryzującym się obecnością ropy w jamie opłucnej, najczęściej w przebiegu zapalenia płuc, z wysoką śmiertelnością 30-dniową sięgającą 10,5% i roczną przekraczającą 19%. Kluczowe czynniki prognostyczne obejmują wiek pacjenta, obecność przetoki oskrzelowo-opłucnowej (zwiększającej 90-dniową śmiertelność o 13,8%), wskaźnik chorób współistniejących Charlsona ≥3, nadużywanie alkoholu, choroby układu sercowo-naczyniowego oraz stan sprawności ≥3. Dodatkowo, cukrzyca, hipoalbuminemia, obecność przegród w płynie oraz gruźlica są istotnymi predyktorami niepowodzenia leczenia, szczególnie w złożonych przypadkach. Stratyfikacja ryzyka według badania PILOT pozwala na przewidywanie 3-miesięcznej śmiertelności na poziomie 2,3% (niski), 9,2% (średni) i 29,3% (wysoki), co umożliwia indywidualizację terapii.

Ropień opłucnej (Empyema) – Rokowanie i przewidywanie wyników leczenia

Wskaźniki śmiertelności
Stratyfikacja ryzyka
Czynniki prognostyczne
Znaczenie chorób współistniejących
Radiologiczne czynniki prognostyczne
Czas hospitalizacji jako wskaźnik rokowania
Znaczenie personalizacji rokowania
Wnioski praktyczne
Kolejne rozdziały

Ropień opłucnej (Empyema) – Rokowanie i przewidywanie wyników leczenia

Ropniak opłucnej (empyema) stanowi poważne schorzenie, charakteryzujące się obecnością ropy w jamie opłucnej, najczęściej w przebiegu zapalenia płuc. Jest to stan zagrażający życiu, obciążony znaczną śmiertelnością i chorobowością, wymagający szczegółowej oceny rokowania dla optymalizacji postępowania terapeutycznego¹².

Wskaźniki śmiertelności

Dane epidemiologiczne wskazują na znaczące obciążenie związane z ropniakiem opłucnej. Śmiertelność 30-dniowa sięga nawet 10,5%, natomiast roczna przekracza 19%³. W niektórych badaniach raportowano śmiertelność ogólną na poziomie 17,1%, co wskazuje na powagę tego schorzenia⁴. Analizy długoterminowe wykazują, że ponad 20% pacjentów z ropniakiem opłucnej umiera, a około 20% wymaga interwencji chirurgicznej w ciągu 12 miesięcy od zakażenia, aby osiągnąć pełne wyzdrowienie⁵.

Stratyfikacja ryzyka

Prospektywne badanie PILOT wykazało możliwość stratyfikacji pacjentów na grupy niskiego, średniego i wysokiego ryzyka, co przekłada się na zróżnicowaną śmiertelność 3-miesięczną – odpowiednio 2,3%, 9,2% i 29,3%⁶. Stratyfikacja ta pozwala na indywidualizację leczenia i monitorowania pacjentów, wpływając na optymalizację opieki medycznej.

Czynniki prognostyczne

Obecność przetoki oskrzelowo-opłucnowej istotnie pogarsza rokowanie, wiążąc się ze wzrostem śmiertelności 90-dniowej szacowanej nawet o 13,8%⁷. Stanowi to jeden z najpoważniejszych negatywnych czynników prognostycznych, wymagających szczególnej uwagi zespołu leczącego⁸.

W całej populacji chorych z ropniakiem opłucnej niezależnymi czynnikami predykcyjnymi śmiertelności są:

Wiek – starsi pacjenci mają gorsze rokowanie
Obecność przetoki – znacząco zwiększa ryzyko zgonu
Wyższy wskaźnik chorób współistniejących Charlsona (≥3) – określa obciążenie dodatkowymi schorzeniami
Nadużywanie alkoholu – wpływa negatywnie na procesy odpornościowe i regeneracyjne
Choroby układu sercowo-naczyniowego (nadciśnienie tętnicze, hiperlipidemia, miażdżyca, migotanie przedsionków)
Stan sprawności ≥3 w skali sprawności – pacjenci o ograniczonej sprawności fizycznej
Podgrupy ropniaka opłucnej – różne typy i etiologie ropniaków

⁹

Dodatkowo, badania wykazały, że cukrzyca, hipoalbuminemia, obecność przegród w płynie (lokalizacja) oraz gruźlica są istotnymi predyktorami niepowodzenia leczenia, szczególnie w przypadkach powikłanych i złożonych wysięków parapneumonicznych oraz ropniaków opłucnej¹⁰.

Znaczenie chorób współistniejących

Szczególnie niekorzystne rokowanie wykazują pacjenci z ropniakiem opłucnej w określonych grupach ryzyka:

Pacjenci z chorobą nowotworową – śmiertelność na poziomie 29,5%
Pacjenci po resekcji płuca – śmiertelność 17,7%
Pacjenci bez operacji i bez nowotworu – śmiertelność 10,7%

¹¹

Analizy przeżycia wskazują, że średni czas przeżycia w przypadku wysięku opłucnowego wynosi 1103,56 dni u pacjentów bez choroby nowotworowej i 1005,29 dni u osób z rozpoznaną chorobą nowotworową¹².

Radiologiczne czynniki prognostyczne

Badania tomografii komputerowej (TK) klatki piersiowej dostarczają istotnych informacji prognostycznych, które coraz częściej są wykorzystywane w ocenie rokowania pacjentów z ropniakiem opłucnej:

Grubość opłucnej ≥2 mm wiąże się z dłuższym pobytem szpitalnym¹³
Obecność wysięku międzypłatowego paradoksalnie koreluje z niższą szacowaną śmiertelnością 90-dniową¹⁴
Obecność guzowatości opłucnej lub masy wiąże się z krótszym średnim czasem przeżycia – odpowiednio 445 i 432 dni, w porównaniu do 1026 i 1018 dni u pacjentów bez tych zmian¹⁵
Radiologiczne rozpoznanie ropniaka pomaga identyfikować pacjentów zagrożonych dłuższym pobytem szpitalnym, z wartością AUC (pole pod krzywą ROC) wynoszącą 0,84¹⁶

Czas hospitalizacji jako wskaźnik rokowania

Ropniak opłucnej wiąże się z istotnie dłuższym czasem hospitalizacji w porównaniu do niepowikłanych wysięków opłucnowych. Mediana pobytu szpitalnego dla pacjentów z ropniakiem wynosi 20 dni, podczas gdy dla innych wysięków opłucnowych – 14 dni¹⁷¹⁸. Wydłużony pobyt szpitalny odzwierciedla złożoność leczenia i wyższe ryzyko powikłań.

Znaczenie personalizacji rokowania

Zdolność dostarczania pacjentom dokładnych, spersonalizowanych informacji prognostycznych powinna być istotnym elementem opieki medycznej¹⁹. Integracja danych klinicznych, laboratoryjnych i radiologicznych pozwala na zwiększenie precyzji oceny rokowania, co umożliwia optymalizację strategii leczenia i poprawę wyników terapeutycznych.

Wnioski praktyczne

W kontekście rosnącej częstości występowania ropniaka opłucnej, szczególną uwagę należy zwrócić na czynniki związane ze zwiększoną śmiertelnością, zwłaszcza na niedawną resekcję płuca i współistniejącą chorobę nowotworową²⁰. Wczesna identyfikacja pacjentów wysokiego ryzyka, oparta na dostępnych czynnikach prognostycznych, pozwala na intensyfikację leczenia i potencjalną poprawę wyników terapeutycznych.

Zaleca się uwzględnianie w systemach oceny rokowniczej czynników takich jak cukrzyca, hipoalbuminemia, obecność przegród w płynie oraz gruźlica, które wykazują istotną wartość predykcyjną dla wyników leczenia ropniaków opłucnej²¹.

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Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Improving Prognostication in Empyema: Is Computed Tomography the Answer?
https://pmc.ncbi.nlm.nih.gov/articles/PMC10257025/
Empyema is a common and often life-threatening condition, with a reported 30-day mortality of up to 10.5% and a 1-year mortality of more than 19%. […] Given this burden on patients and healthcare systems, risk stratification and prognosis in empyema are of utmost importance. […] The prospective PILOT study stratified patients into low-, medium-, and high-risk groups using the aforementioned parameters, with mortality at 3 months of 2.3%, 9.2%, and 29.3%, respectively. […] The authors demonstrate that the presence of bronchopleural fistula predicted higher 90-day mortality, with an estimated difference in 90-day mortality of 13.8%. […] The presence of pleural thickness 2mm was associated with a longer hospital stay. […] Interestingly, the opposite effect was observed with interlobar pleural effusion, which was associated with lower estimated 90-day mortality. […] The authors should be congratulated for being among the first to evaluate the impact of specific CT findings on patient prognosis and outcome in empyema. […] Ultimately, the ability to provide patients with more accurate, personalized prognostic information should be embraced.
#2
https://www.ijclinicaltrials.com/index.php/ijct/article/view/237
Pleural infection is a clinical problem with high mortality and morbidity; 20% of patients with empyema die and approximately 20% require surgery to recover within 12 months of their infection. […] Successful outcome was seen in 107 and 113 had failed outcome. Mortality was 30.50%. By logistic regression method the odds of failed outcome were high with diabetes, hypoalbuminemia, loculation, tuberculosis which can predict the outcome especially complicated and complex parapneumonic effusion, empyema (p0.05). […] Diabetes, hypoalbuminemia, loculation, tuberculosis should be used in the prediction scoring system.
#3 Improving Prognostication in Empyema: Is Computed Tomography the Answer?
https://pmc.ncbi.nlm.nih.gov/articles/PMC10257025/
Empyema is a common and often life-threatening condition, with a reported 30-day mortality of up to 10.5% and a 1-year mortality of more than 19%. […] Given this burden on patients and healthcare systems, risk stratification and prognosis in empyema are of utmost importance. […] The prospective PILOT study stratified patients into low-, medium-, and high-risk groups using the aforementioned parameters, with mortality at 3 months of 2.3%, 9.2%, and 29.3%, respectively. […] The authors demonstrate that the presence of bronchopleural fistula predicted higher 90-day mortality, with an estimated difference in 90-day mortality of 13.8%. […] The presence of pleural thickness 2mm was associated with a longer hospital stay. […] Interestingly, the opposite effect was observed with interlobar pleural effusion, which was associated with lower estimated 90-day mortality. […] The authors should be congratulated for being among the first to evaluate the impact of specific CT findings on patient prognosis and outcome in empyema. […] Ultimately, the ability to provide patients with more accurate, personalized prognostic information should be embraced.
#4 Epidemiology and prognostic factors of pleural empyema – PubMed
https://pubmed.ncbi.nlm.nih.gov/33785584/
Infection of the pleural cavity invariably leads to hospitalisation, and a fatal outcome is not uncommon. […] Mortality was 17.1% in the whole population, 29.5% in the associated cancer group, 17.7% in the post-lung resection group and 10.7% in the no surgery-no cancer group. […] In the whole population, age, presence of fistula, higher Charlson Comorbidity Index (3), alcohol abuse, arterial hypertension, hyperlipidaemia, atheroma, atrial fibrillation, performance status 3 and three subgroups of pleural empyema independently predicted mortality. […] Empyema is increasing in incidence. Factors associated with mortality are recent lung resection and associated diagnosis of cancer.
#5
https://www.ijclinicaltrials.com/index.php/ijct/article/view/237
Pleural infection is a clinical problem with high mortality and morbidity; 20% of patients with empyema die and approximately 20% require surgery to recover within 12 months of their infection. […] Successful outcome was seen in 107 and 113 had failed outcome. Mortality was 30.50%. By logistic regression method the odds of failed outcome were high with diabetes, hypoalbuminemia, loculation, tuberculosis which can predict the outcome especially complicated and complex parapneumonic effusion, empyema (p0.05). […] Diabetes, hypoalbuminemia, loculation, tuberculosis should be used in the prediction scoring system.
#6 Improving Prognostication in Empyema: Is Computed Tomography the Answer?
https://pmc.ncbi.nlm.nih.gov/articles/PMC10257025/
Empyema is a common and often life-threatening condition, with a reported 30-day mortality of up to 10.5% and a 1-year mortality of more than 19%. […] Given this burden on patients and healthcare systems, risk stratification and prognosis in empyema are of utmost importance. […] The prospective PILOT study stratified patients into low-, medium-, and high-risk groups using the aforementioned parameters, with mortality at 3 months of 2.3%, 9.2%, and 29.3%, respectively. […] The authors demonstrate that the presence of bronchopleural fistula predicted higher 90-day mortality, with an estimated difference in 90-day mortality of 13.8%. […] The presence of pleural thickness 2mm was associated with a longer hospital stay. […] Interestingly, the opposite effect was observed with interlobar pleural effusion, which was associated with lower estimated 90-day mortality. […] The authors should be congratulated for being among the first to evaluate the impact of specific CT findings on patient prognosis and outcome in empyema. […] Ultimately, the ability to provide patients with more accurate, personalized prognostic information should be embraced.
#7 Improving Prognostication in Empyema: Is Computed Tomography the Answer?
https://pmc.ncbi.nlm.nih.gov/articles/PMC10257025/
Empyema is a common and often life-threatening condition, with a reported 30-day mortality of up to 10.5% and a 1-year mortality of more than 19%. […] Given this burden on patients and healthcare systems, risk stratification and prognosis in empyema are of utmost importance. […] The prospective PILOT study stratified patients into low-, medium-, and high-risk groups using the aforementioned parameters, with mortality at 3 months of 2.3%, 9.2%, and 29.3%, respectively. […] The authors demonstrate that the presence of bronchopleural fistula predicted higher 90-day mortality, with an estimated difference in 90-day mortality of 13.8%. […] The presence of pleural thickness 2mm was associated with a longer hospital stay. […] Interestingly, the opposite effect was observed with interlobar pleural effusion, which was associated with lower estimated 90-day mortality. […] The authors should be congratulated for being among the first to evaluate the impact of specific CT findings on patient prognosis and outcome in empyema. […] Ultimately, the ability to provide patients with more accurate, personalized prognostic information should be embraced.
#8 Epidemiology and prognostic factors of pleural empyema – PubMed
https://pubmed.ncbi.nlm.nih.gov/33785584/
Infection of the pleural cavity invariably leads to hospitalisation, and a fatal outcome is not uncommon. […] Mortality was 17.1% in the whole population, 29.5% in the associated cancer group, 17.7% in the post-lung resection group and 10.7% in the no surgery-no cancer group. […] In the whole population, age, presence of fistula, higher Charlson Comorbidity Index (3), alcohol abuse, arterial hypertension, hyperlipidaemia, atheroma, atrial fibrillation, performance status 3 and three subgroups of pleural empyema independently predicted mortality. […] Empyema is increasing in incidence. Factors associated with mortality are recent lung resection and associated diagnosis of cancer.
#9 Epidemiology and prognostic factors of pleural empyema – PubMed
https://pubmed.ncbi.nlm.nih.gov/33785584/
Infection of the pleural cavity invariably leads to hospitalisation, and a fatal outcome is not uncommon. […] Mortality was 17.1% in the whole population, 29.5% in the associated cancer group, 17.7% in the post-lung resection group and 10.7% in the no surgery-no cancer group. […] In the whole population, age, presence of fistula, higher Charlson Comorbidity Index (3), alcohol abuse, arterial hypertension, hyperlipidaemia, atheroma, atrial fibrillation, performance status 3 and three subgroups of pleural empyema independently predicted mortality. […] Empyema is increasing in incidence. Factors associated with mortality are recent lung resection and associated diagnosis of cancer.
#10
https://www.ijclinicaltrials.com/index.php/ijct/article/view/237
Pleural infection is a clinical problem with high mortality and morbidity; 20% of patients with empyema die and approximately 20% require surgery to recover within 12 months of their infection. […] Successful outcome was seen in 107 and 113 had failed outcome. Mortality was 30.50%. By logistic regression method the odds of failed outcome were high with diabetes, hypoalbuminemia, loculation, tuberculosis which can predict the outcome especially complicated and complex parapneumonic effusion, empyema (p0.05). […] Diabetes, hypoalbuminemia, loculation, tuberculosis should be used in the prediction scoring system.
#11 Epidemiology and prognostic factors of pleural empyema – PubMed
https://pubmed.ncbi.nlm.nih.gov/33785584/
Infection of the pleural cavity invariably leads to hospitalisation, and a fatal outcome is not uncommon. […] Mortality was 17.1% in the whole population, 29.5% in the associated cancer group, 17.7% in the post-lung resection group and 10.7% in the no surgery-no cancer group. […] In the whole population, age, presence of fistula, higher Charlson Comorbidity Index (3), alcohol abuse, arterial hypertension, hyperlipidaemia, atheroma, atrial fibrillation, performance status 3 and three subgroups of pleural empyema independently predicted mortality. […] Empyema is increasing in incidence. Factors associated with mortality are recent lung resection and associated diagnosis of cancer.
#12 Considerations on Baseline Generation for Imaging AI Studies Illustrated on the CT-Based Prediction of Empyema and Outcome Assessment
https://www.mdpi.com/2313-433X/8/3/50
Empyemas are pleural effusions with pus in the pleural space and are most commonly secondary to pneumonia. While empyema-related hospitalizations increase, empyemas are additionally associated with worse outcomes, such as prolonged admission, more complications and therefore more invasive management compared to parapneumonic effusions. […] Empyema was associated with a longer hospital stay (median = 20 versus 14 days), and findings consistent with pleural carcinomatosis impacted mortality. […] Among all 335 patients with pleural effusion, 51.04% died. Pleural effusion in general had a worse prognosis, with a mean survival of 1103.56 days in cases without underlying malignancy and 1005.29 days in cases with known malignancy. […] Patients with pleural nodularity or mass had shorter mean survival, with 445 days and 432 days compared to 1026 days and 1018 days, respectively. Empyema did not show a higher mortality rate but was associated with increased length of hospital stay (20 versus 14 days median, p = 0.035). […] With an AUC of 0.84, the radiological diagnosis of empyema can help to identify patients with longer hospital stays.
#13 Improving Prognostication in Empyema: Is Computed Tomography the Answer?
https://pmc.ncbi.nlm.nih.gov/articles/PMC10257025/
Empyema is a common and often life-threatening condition, with a reported 30-day mortality of up to 10.5% and a 1-year mortality of more than 19%. […] Given this burden on patients and healthcare systems, risk stratification and prognosis in empyema are of utmost importance. […] The prospective PILOT study stratified patients into low-, medium-, and high-risk groups using the aforementioned parameters, with mortality at 3 months of 2.3%, 9.2%, and 29.3%, respectively. […] The authors demonstrate that the presence of bronchopleural fistula predicted higher 90-day mortality, with an estimated difference in 90-day mortality of 13.8%. […] The presence of pleural thickness 2mm was associated with a longer hospital stay. […] Interestingly, the opposite effect was observed with interlobar pleural effusion, which was associated with lower estimated 90-day mortality. […] The authors should be congratulated for being among the first to evaluate the impact of specific CT findings on patient prognosis and outcome in empyema. […] Ultimately, the ability to provide patients with more accurate, personalized prognostic information should be embraced.
#14 Improving Prognostication in Empyema: Is Computed Tomography the Answer?
https://pmc.ncbi.nlm.nih.gov/articles/PMC10257025/
Empyema is a common and often life-threatening condition, with a reported 30-day mortality of up to 10.5% and a 1-year mortality of more than 19%. […] Given this burden on patients and healthcare systems, risk stratification and prognosis in empyema are of utmost importance. […] The prospective PILOT study stratified patients into low-, medium-, and high-risk groups using the aforementioned parameters, with mortality at 3 months of 2.3%, 9.2%, and 29.3%, respectively. […] The authors demonstrate that the presence of bronchopleural fistula predicted higher 90-day mortality, with an estimated difference in 90-day mortality of 13.8%. […] The presence of pleural thickness 2mm was associated with a longer hospital stay. […] Interestingly, the opposite effect was observed with interlobar pleural effusion, which was associated with lower estimated 90-day mortality. […] The authors should be congratulated for being among the first to evaluate the impact of specific CT findings on patient prognosis and outcome in empyema. […] Ultimately, the ability to provide patients with more accurate, personalized prognostic information should be embraced.
#15 Considerations on Baseline Generation for Imaging AI Studies Illustrated on the CT-Based Prediction of Empyema and Outcome Assessment
https://www.mdpi.com/2313-433X/8/3/50
Empyemas are pleural effusions with pus in the pleural space and are most commonly secondary to pneumonia. While empyema-related hospitalizations increase, empyemas are additionally associated with worse outcomes, such as prolonged admission, more complications and therefore more invasive management compared to parapneumonic effusions. […] Empyema was associated with a longer hospital stay (median = 20 versus 14 days), and findings consistent with pleural carcinomatosis impacted mortality. […] Among all 335 patients with pleural effusion, 51.04% died. Pleural effusion in general had a worse prognosis, with a mean survival of 1103.56 days in cases without underlying malignancy and 1005.29 days in cases with known malignancy. […] Patients with pleural nodularity or mass had shorter mean survival, with 445 days and 432 days compared to 1026 days and 1018 days, respectively. Empyema did not show a higher mortality rate but was associated with increased length of hospital stay (20 versus 14 days median, p = 0.035). […] With an AUC of 0.84, the radiological diagnosis of empyema can help to identify patients with longer hospital stays.
#16 Considerations on Baseline Generation for Imaging AI Studies Illustrated on the CT-Based Prediction of Empyema and Outcome Assessment
https://www.mdpi.com/2313-433X/8/3/50
Empyemas are pleural effusions with pus in the pleural space and are most commonly secondary to pneumonia. While empyema-related hospitalizations increase, empyemas are additionally associated with worse outcomes, such as prolonged admission, more complications and therefore more invasive management compared to parapneumonic effusions. […] Empyema was associated with a longer hospital stay (median = 20 versus 14 days), and findings consistent with pleural carcinomatosis impacted mortality. […] Among all 335 patients with pleural effusion, 51.04% died. Pleural effusion in general had a worse prognosis, with a mean survival of 1103.56 days in cases without underlying malignancy and 1005.29 days in cases with known malignancy. […] Patients with pleural nodularity or mass had shorter mean survival, with 445 days and 432 days compared to 1026 days and 1018 days, respectively. Empyema did not show a higher mortality rate but was associated with increased length of hospital stay (20 versus 14 days median, p = 0.035). […] With an AUC of 0.84, the radiological diagnosis of empyema can help to identify patients with longer hospital stays.
#17 Considerations on Baseline Generation for Imaging AI Studies Illustrated on the CT-Based Prediction of Empyema and Outcome Assessment
https://www.mdpi.com/2313-433X/8/3/50
Empyemas are pleural effusions with pus in the pleural space and are most commonly secondary to pneumonia. While empyema-related hospitalizations increase, empyemas are additionally associated with worse outcomes, such as prolonged admission, more complications and therefore more invasive management compared to parapneumonic effusions. […] Empyema was associated with a longer hospital stay (median = 20 versus 14 days), and findings consistent with pleural carcinomatosis impacted mortality. […] Among all 335 patients with pleural effusion, 51.04% died. Pleural effusion in general had a worse prognosis, with a mean survival of 1103.56 days in cases without underlying malignancy and 1005.29 days in cases with known malignancy. […] Patients with pleural nodularity or mass had shorter mean survival, with 445 days and 432 days compared to 1026 days and 1018 days, respectively. Empyema did not show a higher mortality rate but was associated with increased length of hospital stay (20 versus 14 days median, p = 0.035). […] With an AUC of 0.84, the radiological diagnosis of empyema can help to identify patients with longer hospital stays.
#18 Considerations on Baseline Generation for Imaging AI Studies Illustrated on the CT-Based Prediction of Empyema and Outcome Assessment
https://www.mdpi.com/2313-433X/8/3/50
Empyemas are pleural effusions with pus in the pleural space and are most commonly secondary to pneumonia. While empyema-related hospitalizations increase, empyemas are additionally associated with worse outcomes, such as prolonged admission, more complications and therefore more invasive management compared to parapneumonic effusions. […] Empyema was associated with a longer hospital stay (median = 20 versus 14 days), and findings consistent with pleural carcinomatosis impacted mortality. […] Among all 335 patients with pleural effusion, 51.04% died. Pleural effusion in general had a worse prognosis, with a mean survival of 1103.56 days in cases without underlying malignancy and 1005.29 days in cases with known malignancy. […] Patients with pleural nodularity or mass had shorter mean survival, with 445 days and 432 days compared to 1026 days and 1018 days, respectively. Empyema did not show a higher mortality rate but was associated with increased length of hospital stay (20 versus 14 days median, p = 0.035). […] With an AUC of 0.84, the radiological diagnosis of empyema can help to identify patients with longer hospital stays.
#19 Improving Prognostication in Empyema: Is Computed Tomography the Answer?
https://pmc.ncbi.nlm.nih.gov/articles/PMC10257025/
Empyema is a common and often life-threatening condition, with a reported 30-day mortality of up to 10.5% and a 1-year mortality of more than 19%. […] Given this burden on patients and healthcare systems, risk stratification and prognosis in empyema are of utmost importance. […] The prospective PILOT study stratified patients into low-, medium-, and high-risk groups using the aforementioned parameters, with mortality at 3 months of 2.3%, 9.2%, and 29.3%, respectively. […] The authors demonstrate that the presence of bronchopleural fistula predicted higher 90-day mortality, with an estimated difference in 90-day mortality of 13.8%. […] The presence of pleural thickness 2mm was associated with a longer hospital stay. […] Interestingly, the opposite effect was observed with interlobar pleural effusion, which was associated with lower estimated 90-day mortality. […] The authors should be congratulated for being among the first to evaluate the impact of specific CT findings on patient prognosis and outcome in empyema. […] Ultimately, the ability to provide patients with more accurate, personalized prognostic information should be embraced.
#20 Epidemiology and prognostic factors of pleural empyema – PubMed
https://pubmed.ncbi.nlm.nih.gov/33785584/
Infection of the pleural cavity invariably leads to hospitalisation, and a fatal outcome is not uncommon. […] Mortality was 17.1% in the whole population, 29.5% in the associated cancer group, 17.7% in the post-lung resection group and 10.7% in the no surgery-no cancer group. […] In the whole population, age, presence of fistula, higher Charlson Comorbidity Index (3), alcohol abuse, arterial hypertension, hyperlipidaemia, atheroma, atrial fibrillation, performance status 3 and three subgroups of pleural empyema independently predicted mortality. […] Empyema is increasing in incidence. Factors associated with mortality are recent lung resection and associated diagnosis of cancer.
#21
https://www.ijclinicaltrials.com/index.php/ijct/article/view/237
Pleural infection is a clinical problem with high mortality and morbidity; 20% of patients with empyema die and approximately 20% require surgery to recover within 12 months of their infection. […] Successful outcome was seen in 107 and 113 had failed outcome. Mortality was 30.50%. By logistic regression method the odds of failed outcome were high with diabetes, hypoalbuminemia, loculation, tuberculosis which can predict the outcome especially complicated and complex parapneumonic effusion, empyema (p0.05). […] Diabetes, hypoalbuminemia, loculation, tuberculosis should be used in the prediction scoring system.