Study objectives: To determine the predicting factors
for outcome of tube thoracostomy in patients with complicated
parapneumonic effusion (CPE) or empyema.
settings: Retrospective chart review over a 55-month period at a
tertiary referred medical center.
measurements: The medical charts of patients with empyema or CPE
were reviewed. Data including age, gender, clinical symptoms, important
underlying diseases, leukocyte count, duration of preadmission
symptoms, interval from first procedure to second procedure, the time
from first procedure to discharge (recovery time), the amount of
effusion drained, administration of intrapleural streptokinase, chest
tube size and position, loculation of pleural effusion, and
characteristics and culture results of pleural effusion were recorded
and compared between groups of patients with successful and failed
outcome of tube thoracostomy drainage.
hundred twenty-one patients were selected for study. One hundred of
these patients had received tube thoracostomy drainage with 53
successful outcomes and 47 failed outcomes of chest tube drainage.
Nineteen patients received decortication directly, and the other two
received antibiotics alone. Univariate analysis showed that pleural
effusion leukocyte count, effusion amount, and loculation of pleural
effusion were significantly related to the outcome of chest tube
drainage. Multiple logistic regression analysis demonstrated that
loculation and pleural effusion leukocyte count ≤ 6,400/μL were
the only independent predicting factors related to failure of tube
and pleural effusion leukocyte count ≤ 6,400/μL were independent
predicting factors of poor outcome of tube thoracostomy drainage. These
results suggest that if the initial attempt at chest tube drainage
fails, early surgical intervention should be considered in good
surgical candidates with loculated empyema or pleural effusion with
leukocyte count ≤ 6,400/μL.
Abbreviations: AROC = area under
the receiver operating characteristic curve; CI = confidence
interval; CPE = complicated parapneumonic effusion; D24 = the
volume of pleural effusion drained from the chest tube within the first
24 h; LDH = lactate dehydrogenase; PMN = polymorphonuclear
leukocyte; TNF = tumor necrosis factor