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Thoracic Empyema: A 12-Year Study from a UK Tertiary Cardiothoracic Referral Centre

BACKGROUND: Empyema is an increasingly frequent clinical problem worldwide, and has substantial morbidity and mortality. Our objectives were to identify the clinical, surgical and microbiological features, and management outcomes, of empyema. METHODS: A retrospective observational study over 12 year...

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Autores principales: Marks, Daniel J. B., Fisk, Marie D., Koo, Chieh Y., Pavlou, Menelaos, Peck, Lorraine, Lee, Simon F., Lawrence, David, Macrae, M. Bruce, Wilson, A. Peter R., Brown, Jeremy S., Miller, Robert F., Zumla, Alimuddin I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262802/
https://www.ncbi.nlm.nih.gov/pubmed/22276145
http://dx.doi.org/10.1371/journal.pone.0030074
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author Marks, Daniel J. B.
Fisk, Marie D.
Koo, Chieh Y.
Pavlou, Menelaos
Peck, Lorraine
Lee, Simon F.
Lawrence, David
Macrae, M. Bruce
Wilson, A. Peter R.
Brown, Jeremy S.
Miller, Robert F.
Zumla, Alimuddin I.
author_facet Marks, Daniel J. B.
Fisk, Marie D.
Koo, Chieh Y.
Pavlou, Menelaos
Peck, Lorraine
Lee, Simon F.
Lawrence, David
Macrae, M. Bruce
Wilson, A. Peter R.
Brown, Jeremy S.
Miller, Robert F.
Zumla, Alimuddin I.
author_sort Marks, Daniel J. B.
collection PubMed
description BACKGROUND: Empyema is an increasingly frequent clinical problem worldwide, and has substantial morbidity and mortality. Our objectives were to identify the clinical, surgical and microbiological features, and management outcomes, of empyema. METHODS: A retrospective observational study over 12 years (1999–2010) was carried out at The Heart Hospital, London, United Kingdom. Patients with empyema were identified by screening the hospital electronic ‘Clinical Data Repository’. Demographics, clinical and microbiological characteristics, underlying risk factors, peri-operative blood tests, treatment and outcomes were identified. Univariable and multivariable statistical analyses were performed. RESULTS: Patients (n = 406) were predominantly male (74.1%); median age = 53 years (IQR = 37–69). Most empyema were community-acquired (87.4%) and right-sided (57.4%). Microbiological diagnosis was obtained in 229 (56.4%) patients, and included streptococci (16.3%), staphylococci (15.5%), Gram-negative organisms (8.9%), anaerobes (5.7%), pseudomonads (4.4%) and mycobacteria (9.1%); 8.4% were polymicrobial. Most (68%) cases were managed by open thoracotomy and decortication. Video-assisted thoracoscopic surgery (VATS) reduced hospitalisation from 10 to seven days (P = 0.0005). All-cause complication rate was 25.1%, and 28 day mortality 5.7%. Predictors of early mortality included: older age (P = 0.006), major co-morbidity (P = 0.01), malnutrition (P = 0.001), elevated red cell distribution width (RDW, P<0.001) and serum alkaline phosphatase (P = 0.004), and reduced serum albumin (P = 0.01) and haemoglobin (P = 0.04). CONCLUSIONS: Empyema remains an important cause of morbidity and hospital admissions. Microbiological diagnosis was only achieved in just over 50% of cases, and tuberculosis is a notable causative organism. Treatment of empyema with VATS may reduce duration of hospital stay. Raised RDW appears to associate with early mortality.
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spelling pubmed-32628022012-01-24 Thoracic Empyema: A 12-Year Study from a UK Tertiary Cardiothoracic Referral Centre Marks, Daniel J. B. Fisk, Marie D. Koo, Chieh Y. Pavlou, Menelaos Peck, Lorraine Lee, Simon F. Lawrence, David Macrae, M. Bruce Wilson, A. Peter R. Brown, Jeremy S. Miller, Robert F. Zumla, Alimuddin I. PLoS One Research Article BACKGROUND: Empyema is an increasingly frequent clinical problem worldwide, and has substantial morbidity and mortality. Our objectives were to identify the clinical, surgical and microbiological features, and management outcomes, of empyema. METHODS: A retrospective observational study over 12 years (1999–2010) was carried out at The Heart Hospital, London, United Kingdom. Patients with empyema were identified by screening the hospital electronic ‘Clinical Data Repository’. Demographics, clinical and microbiological characteristics, underlying risk factors, peri-operative blood tests, treatment and outcomes were identified. Univariable and multivariable statistical analyses were performed. RESULTS: Patients (n = 406) were predominantly male (74.1%); median age = 53 years (IQR = 37–69). Most empyema were community-acquired (87.4%) and right-sided (57.4%). Microbiological diagnosis was obtained in 229 (56.4%) patients, and included streptococci (16.3%), staphylococci (15.5%), Gram-negative organisms (8.9%), anaerobes (5.7%), pseudomonads (4.4%) and mycobacteria (9.1%); 8.4% were polymicrobial. Most (68%) cases were managed by open thoracotomy and decortication. Video-assisted thoracoscopic surgery (VATS) reduced hospitalisation from 10 to seven days (P = 0.0005). All-cause complication rate was 25.1%, and 28 day mortality 5.7%. Predictors of early mortality included: older age (P = 0.006), major co-morbidity (P = 0.01), malnutrition (P = 0.001), elevated red cell distribution width (RDW, P<0.001) and serum alkaline phosphatase (P = 0.004), and reduced serum albumin (P = 0.01) and haemoglobin (P = 0.04). CONCLUSIONS: Empyema remains an important cause of morbidity and hospital admissions. Microbiological diagnosis was only achieved in just over 50% of cases, and tuberculosis is a notable causative organism. Treatment of empyema with VATS may reduce duration of hospital stay. Raised RDW appears to associate with early mortality. Public Library of Science 2012-01-20 /pmc/articles/PMC3262802/ /pubmed/22276145 http://dx.doi.org/10.1371/journal.pone.0030074 Text en Marks et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Marks, Daniel J. B.
Fisk, Marie D.
Koo, Chieh Y.
Pavlou, Menelaos
Peck, Lorraine
Lee, Simon F.
Lawrence, David
Macrae, M. Bruce
Wilson, A. Peter R.
Brown, Jeremy S.
Miller, Robert F.
Zumla, Alimuddin I.
Thoracic Empyema: A 12-Year Study from a UK Tertiary Cardiothoracic Referral Centre
title Thoracic Empyema: A 12-Year Study from a UK Tertiary Cardiothoracic Referral Centre
title_full Thoracic Empyema: A 12-Year Study from a UK Tertiary Cardiothoracic Referral Centre
title_fullStr Thoracic Empyema: A 12-Year Study from a UK Tertiary Cardiothoracic Referral Centre
title_full_unstemmed Thoracic Empyema: A 12-Year Study from a UK Tertiary Cardiothoracic Referral Centre
title_short Thoracic Empyema: A 12-Year Study from a UK Tertiary Cardiothoracic Referral Centre
title_sort thoracic empyema: a 12-year study from a uk tertiary cardiothoracic referral centre
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262802/
https://www.ncbi.nlm.nih.gov/pubmed/22276145
http://dx.doi.org/10.1371/journal.pone.0030074
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