Department of Cardiology, The Heart Hospital, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
PLoS One. 2012;7(1):e30074. doi: 10.1371/journal.pone.0030074. Epub 2012 Jan 20.
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.
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.
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).
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.
脓胸是一种在全球范围内日益频繁出现的临床问题，具有较高的发病率和死亡率。我们的目的是确定脓胸的临床、外科和微生物学特征以及治疗结果。
在英国伦敦的心脏医院进行了一项回顾性观察研究，时间跨度为 12 年（1999 年至 2010 年）。通过筛选医院电子“临床数据存储库”来识别脓胸患者。确定了患者的人口统计学、临床和微生物学特征、潜在的危险因素、围手术期血液检查、治疗和结果。进行了单变量和多变量统计分析。
患者（n=406）主要为男性（74.1%）；中位年龄=53 岁（IQR=37-69）。大多数脓胸为社区获得性（87.4%）和右侧（57.4%）。229 名（56.4%）患者获得了微生物学诊断，包括链球菌（16.3%）、葡萄球菌（15.5%）、革兰氏阴性菌（8.9%）、厌氧菌（5.7%）、假单胞菌（4.4%）和分枝杆菌（9.1%）；8.4%为多种微生物感染。大多数（68%）病例采用开胸和胸廓切开术治疗。电视辅助胸腔镜手术（VATS）将住院时间从 10 天缩短至 7 天（P=0.0005）。总并发症发生率为 25.1%，28 天死亡率为 5.7%。早期死亡的预测因素包括：年龄较大（P=0.006）、主要合并症（P=0.01）、营养不良（P=0.001）、红细胞分布宽度（RDW）升高（P<0.001）和血清碱性磷酸酶升高（P=0.004），以及血清白蛋白（P=0.01）和血红蛋白（P=0.04）降低。
脓胸仍然是发病率和住院的重要原因。仅超过 50%的病例获得了微生物学诊断，结核病是一个显著的致病因素。使用 VATS 治疗脓胸可能会缩短住院时间。RDW 升高似乎与早期死亡有关。
