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Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study
BACKGROUND: The clinical impact of phenotyping empyema is poorly described. This study was designed to evaluate clinical characteristics and outcomes based on the two readily available parameters, pleural fluid culture status and macroscopic fluid appearance. METHODS: A retrospective study was condu...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
European Respiratory Society
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10068520/ https://www.ncbi.nlm.nih.gov/pubmed/37020833 http://dx.doi.org/10.1183/23120541.00534-2022 |
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author | Chan, Ka Pang Ng, Susanna So Shan Ling, Kwun Cheung Ng, Ka Ching Lo, Lai Ping Yip, Wing Ho Ngai, Jenny Chun Li To, Kin Wang Ko, Fanny Wai San Lee, Yun Chor Gary Hui, David Shu Cheong |
author_facet | Chan, Ka Pang Ng, Susanna So Shan Ling, Kwun Cheung Ng, Ka Ching Lo, Lai Ping Yip, Wing Ho Ngai, Jenny Chun Li To, Kin Wang Ko, Fanny Wai San Lee, Yun Chor Gary Hui, David Shu Cheong |
author_sort | Chan, Ka Pang |
collection | PubMed |
description | BACKGROUND: The clinical impact of phenotyping empyema is poorly described. This study was designed to evaluate clinical characteristics and outcomes based on the two readily available parameters, pleural fluid culture status and macroscopic fluid appearance. METHODS: A retrospective study was conducted on patients with empyema hospitalised between 2013 and 2020. Empyema was classified into culture-positive empyema (CPE) or culture-negative empyema (CNE) and pus-appearing empyema (PAE) or non-pus-appearing empyema (non-PAE) based on the pleural fluid culture status and macroscopic fluid appearance, respectively. RESULTS: Altogether, 212 patients had confirmed empyema (CPE: n=188, CNE: n=24; PAE: n=118, non-PAE: n=94). The cohort was predominantly male (n=163, 76.9%) with a mean age of 65.0±13.6 years. Most patients (n=180, 84.9%) had at least one comorbidity. Patients with CPE had higher rates of in-hospital mortality (19.1% versus 0.0%, p=0.017) and 90-day mortality (18.6% versus 0.0%, p=0.017) and more extrapulmonary sources of infection (29.8% versus 8.3%, p=0.026) when compared with patients with CNE. No significant difference in mortality rate was found between PAE and non-PAE during the in-hospital stay and at 30 days and 90 days. Patients with PAE had less extrapulmonary sources of infection (20.3% versus 36.2%, p=0.010) and more anaerobic infection (40.9% versus 24.5%, p=0.017) than those with non-PAE. The median RAPID (renal, age, purulence, infection source, and dietary factors) scores were higher in the CPE and non-PAE groups. After adjusting for covariates, culture positivity was not independently associated with mortality on multivariable analysis. CONCLUSION: Empyema is a heterogeneous disease with different clinical characteristics. Phenotyping empyema into different subclasses based on pleural fluid microbiological results and macroscopic fluid appearance provides insight into the underlying bacteriology, source of infection and subsequent clinical outcomes. |
format | Online Article Text |
id | pubmed-10068520 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-100685202023-04-04 Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study Chan, Ka Pang Ng, Susanna So Shan Ling, Kwun Cheung Ng, Ka Ching Lo, Lai Ping Yip, Wing Ho Ngai, Jenny Chun Li To, Kin Wang Ko, Fanny Wai San Lee, Yun Chor Gary Hui, David Shu Cheong ERJ Open Res Original Research Articles BACKGROUND: The clinical impact of phenotyping empyema is poorly described. This study was designed to evaluate clinical characteristics and outcomes based on the two readily available parameters, pleural fluid culture status and macroscopic fluid appearance. METHODS: A retrospective study was conducted on patients with empyema hospitalised between 2013 and 2020. Empyema was classified into culture-positive empyema (CPE) or culture-negative empyema (CNE) and pus-appearing empyema (PAE) or non-pus-appearing empyema (non-PAE) based on the pleural fluid culture status and macroscopic fluid appearance, respectively. RESULTS: Altogether, 212 patients had confirmed empyema (CPE: n=188, CNE: n=24; PAE: n=118, non-PAE: n=94). The cohort was predominantly male (n=163, 76.9%) with a mean age of 65.0±13.6 years. Most patients (n=180, 84.9%) had at least one comorbidity. Patients with CPE had higher rates of in-hospital mortality (19.1% versus 0.0%, p=0.017) and 90-day mortality (18.6% versus 0.0%, p=0.017) and more extrapulmonary sources of infection (29.8% versus 8.3%, p=0.026) when compared with patients with CNE. No significant difference in mortality rate was found between PAE and non-PAE during the in-hospital stay and at 30 days and 90 days. Patients with PAE had less extrapulmonary sources of infection (20.3% versus 36.2%, p=0.010) and more anaerobic infection (40.9% versus 24.5%, p=0.017) than those with non-PAE. The median RAPID (renal, age, purulence, infection source, and dietary factors) scores were higher in the CPE and non-PAE groups. After adjusting for covariates, culture positivity was not independently associated with mortality on multivariable analysis. CONCLUSION: Empyema is a heterogeneous disease with different clinical characteristics. Phenotyping empyema into different subclasses based on pleural fluid microbiological results and macroscopic fluid appearance provides insight into the underlying bacteriology, source of infection and subsequent clinical outcomes. European Respiratory Society 2023-04-03 /pmc/articles/PMC10068520/ /pubmed/37020833 http://dx.doi.org/10.1183/23120541.00534-2022 Text en Copyright ©The authors 2023 https://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org) |
spellingShingle | Original Research Articles Chan, Ka Pang Ng, Susanna So Shan Ling, Kwun Cheung Ng, Ka Ching Lo, Lai Ping Yip, Wing Ho Ngai, Jenny Chun Li To, Kin Wang Ko, Fanny Wai San Lee, Yun Chor Gary Hui, David Shu Cheong Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study |
title | Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study |
title_full | Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study |
title_fullStr | Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study |
title_full_unstemmed | Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study |
title_short | Phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study |
title_sort | phenotyping empyema by pleural fluid culture results and macroscopic appearance: an 8-year retrospective study |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10068520/ https://www.ncbi.nlm.nih.gov/pubmed/37020833 http://dx.doi.org/10.1183/23120541.00534-2022 |
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