PURPOSE: Essentials in medical treatment of complicated parapneumonic effusion (CPE) or empyema are early adequate antibiotics and prompt drainage. However, some patients fail medical treatment and need additional surgical treatment. Little is known about what factors are involved it. We investigated predicting factors for failure of medical treatment in comparison with clinical manifestations between success and failure groups of medical treatment in patients with CPE or empyema.
METHODS: We retrospectively studied the differences in clinical manifestations of the two groups in patients with CPE or empyema, admitting to St. Vincent's hospital from January 2002 to June 2009.
RESULTS: Failure rate of medical treatment was 29.7%. In univariate analysis, significant factors associated with outcome of medical treatment are age, smoking history, symptom duration, serum albumin level, and pleural fluid glucose and lactate dehydrogenase level. Multivariate logistic regression analysis with these factors identified age and symptom duration as significant independent predicting factors for failure of medical treatment, with odds ratios of 0.871 (p=0.013) and 0.797 (p=0.026), respectively. Cutoff value was 50.5 years for age and 4.5 days for symptom duration by receiver operating characteristic curve. Area under the curve of the age and symptom duration was 0.792 (95% CI, 0.641 ~ 0.942) and 0.787 (95% CI, 0.625 ~ 0.949), respectively.
CONCLUSIONS: We identified that age under 50.5 yrs and symptom duration under 4.5 days were independent predicting factors for failure of medical treatment in patients with CPE or empyema. This could suggest a new evidence to establish an indication for best optimal treatment in patients with CPE or empyema. For this, further large prospective study will be required.
CLINICAL IMPLICATIONS: If a CPE or empyema patient with age under 50.5 years and symptom duration under 4.5 days would be good surgical candidate, early surgical treatment without additional medical treatment after failed initial medical treatment or initial surgical treatment without medical treatment could be considered carefully.
DISCLOSURE: The following authors have nothing to disclose: Sung Kyoung Kim, Hyeon Hui Kang, Ju Sang Kim, Sang Haak Lee, Joong Hyun Ahn, Soon Seog Kwon, Young Kyoon Kim, Hwa Sik Moon, Jeong Sup Song, Chi Hong Kim
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