The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Factors predictive of the failure of medical treatment in patients with pleural infection

  • Kim, Sung-Kyoung (Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kang, Chul Ung (Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Song, So Hyang (Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Cho, Deog Gon (Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Cho, Kyu Do (Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Chi Hong (Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2013.10.14
  • Accepted : 2014.02.20
  • Published : 2014.09.01
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Abstract

Background/Aims: The clinical outcomes of some patients with pleural infection may be favorable with medical treatment alone, but in others, the disease progresses and requires additional surgical treatment. However, little is known about the factors affecting this difference. The aim of this study was to investigate the factors predictive of failure of medical treatment in patients with pleural infection. Methods: A cohort of 127 consecutive patients who were admitted to the hospital with pleural infection was studied. Clinical manifestations and laboratory findings in patients in whom medical treatment succeeded or failed were reviewed. Results: In univariate analysis, the significant factors associated with medical treatment outcome were age, smoking history, duration of chief complaint, serum albumin level, and pleural fluid glucose and lactate dehydrogenase levels (p <0.05). Multivariate logistic regression analysis identified age and duration of chief complaint as independent predictive factors for failure of medical treatment, with odds ratios of 0.871 (p = 0.013) and 0.797 (p = 0.026), respectively. Receiver operating characteristic curve analysis determined cutoff values of 50.5 years for age and 4.5 days for duration of chief complaint. Conclusions: We demonstrated that a younger age < 50.5 years and shorter duration of chief complaint < 4.5 days were independent predictive factors for the failure of medical treatment in patients with pleural infection. This suggests their role as evaluative criteria in setting indications for the optimal treatment in patients with pleural infection. A larger, prospective study is required to confirm these findings.

Keywords

References

  1. Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc 2006;3:75-80. https://doi.org/10.1513/pats.200510-113JH
  2. Light RW, Girard WM, Jenkinson SG, George RB. Parapneumonic effusions. Am J Med 1980;69:507-512. https://doi.org/10.1016/0002-9343(80)90460-X
  3. Colice GL, Curtis A, Deslauriers J, et al. Medical and surgical treatment of parapneumonic effusions: an evidence- based guideline. Chest 2000;118:1158-1171. https://doi.org/10.1378/chest.118.4.1158
  4. Davies HE, Davies RJ, Davies CW; BTS Pleural Disease Guideline Group. Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65 Suppl 2:ii41-ii53.
  5. Cameron R, Davies HR. Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev 2008;(2):CD002312.
  6. Maskell NA, Davies CW, Nunn AJ, et al. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005;352:865-874. https://doi.org/10.1056/NEJMoa042473
  7. Tokuda Y, Matsushima D, Stein GH, Miyagi S. Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis. Chest 2006;129:783-790. https://doi.org/10.1378/chest.129.3.783
  8. Luh SP, Chou MC, Wang LS, Chen JY, Tsai TP. Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas: outcome of 234 patients. Chest 2005;127:1427-1432. https://doi.org/10.1378/chest.127.4.1427
  9. Petrakis IE, Kogerakis NE, Drositis IE, Lasithiotakis KG, Bouros D, Chalkiadakis GE. Video-assisted thoracoscopic surgery for thoracic empyema: primarily, or after fibrinolytic therapy failure? Am J Surg 2004;187:471-474. https://doi.org/10.1016/j.amjsurg.2003.12.048
  10. LeMense GP, Strange C, Sahn SA. Empyema thoracis: therapeutic management and outcome. Chest 1995;107:1532-1537. https://doi.org/10.1378/chest.107.6.1532
  11. Light RW. A new classification of parapneumonic effusions and empyema. Chest 1995;108:299-301. https://doi.org/10.1378/chest.108.2.299
  12. Aleman C, Alegre J, Monasterio J, et al. Association between inflammatory mediators and the fibrinolysis system in infectious pleural effusions. Clin Sci (Lond) 2003;105:601-607. https://doi.org/10.1042/CS20030115
  13. Porcel JM, Vives M, Esquerda A. Tumor necrosis factor-alpha in pleural fluid: a marker of complicated parapneumonic effusions. Chest 2004;125:160-164. https://doi.org/10.1378/chest.125.1.160
  14. Aderem A, Ulevitch RJ. Toll-like receptors in the induction of the innate immune response. Nature 2000;406:782-787. https://doi.org/10.1038/35021228
  15. Zhang P, Summer WR, Bagby GJ, Nelson S. Innate immunity and pulmonary host defense. Immunol Rev 2000;173:39-51. https://doi.org/10.1034/j.1600-065X.2000.917306.x
  16. Gomez CR, Nomellini V, Faunce DE, Kovacs EJ. Innate immunity and aging. Exp Gerontol 2008;43:718-728. https://doi.org/10.1016/j.exger.2008.05.016
  17. Poe RH, Marin MG, Israel RH, Kallay MC. Utility of pleural fluid analysis in predicting tube thoracostomy/decortication in parapneumonic effusions. Chest 1991;100:963-967. https://doi.org/10.1378/chest.100.4.963
  18. Sopori ML, Kozak W. Immunomodulatory effects of cigarette smoke. J Neuroimmunol 1998;83:148-156. https://doi.org/10.1016/S0165-5728(97)00231-2
  19. Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EF. Systemic effects of smoking. Chest 2007;131:1557-1566. https://doi.org/10.1378/chest.06-2179
  20. Arnson Y, Shoenfeld Y, Amital H. Effects of tobacco smoke on immunity, inflammation and autoimmunity. J Autoimmun 2010;34:J258-J265. https://doi.org/10.1016/j.jaut.2009.12.003
  21. Gom I, Fukushima H, Shiraki M, et al. Relationship between serum albumin level and aging in community- dwelling self-supported elderly population. J Nutr Sci Vitaminol (Tokyo) 2007;53:37-42. https://doi.org/10.3177/jnsv.53.37
  22. Ashbaugh DG. Empyema thoracis: factors influencing morbidity and mortality. Chest 1991;99:1162-1165. https://doi.org/10.1378/chest.99.5.1162
  23. Cham CW, Haq SM, Rahamim J. Empyema thoracis: a problem with late referral? Thorax 1993;48:925-927. https://doi.org/10.1136/thx.48.9.925
  24. Davies CW, Kearney SE, Gleeson FV, Davies RJ. Predictors of outcome and long-term survival in patients with pleural infection. Am J Respir Crit Care Med 1999;160(5 Pt 1):1682-1687. https://doi.org/10.1164/ajrccm.160.5.9903002
  25. Huang HC, Chang HY, Chen CW, Lee CH, Hsiue TR. Predicting factors for outcome of tube thoracostomy in complicated parapneumonic effusion for empyema. Chest 1999;115:751-756. https://doi.org/10.1378/chest.115.3.751

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