Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st St. SW Rochester, MN 55902, USA.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st St. SW Rochester, MN 55902, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Dig Liver Dis. 2022 Aug;54(8):1015-1020. doi: 10.1016/j.dld.2022.02.007. Epub 2022 Mar 26.
Spontaneous bacterial empyema (SBEM) is a rare complication of hepatic hydrothorax characterized by hydrothorax infection in the absence of pneumonia.
We conducted this study to compare clinical outcomes in SBEM patients who underwent early thoracentesis (ET) (≤ 24 h from presentation) versus those who underwent delayed thoracentesis (DT). All patients diagnosed with SBEM at Mayo Clinic Rochester, Minnesota from January 1st 1999 to December 31st 2020 were reviewed. Demographics, pleural fluid studies, laboratory results and clinical outcomes were analyzed.
A total of 54 SBEM patients (27 ET and 27 DT) were identified with 38 (70.4%) of patients presenting with right-sided effusions. Both groups had similar baseline characteristics. The rate of ICU admission was significantly higher in the DT group (15 (55.6%) vs. 7 (25.9%) patients, P = 0.027). Patients with DT had similar rate of AKI (11 (40.7%) vs. 6 (22.2%) patients, P = 0.074). In-hospital mortality (11 (40.7%) vs. 2 (7.4%) patients, P = 0.004), 3-month mortality (16 (59.3%) vs. 2 (7.4%) patients, P < 0.001) and 1-year mortality rate (21 (77.8%) vs. 6 (22.2%) patients, P < 0.001) were higher in the DT group.
Patients with SBEM who underwent thoracentesis after 24 h from presentation (DT) had higher rates of mortality and ICU admission compared to patients who received early thoracentesis. Thoracentesis should be performed early in patients with suspected SBEM since it may improve survival.
自发性细菌性脓胸 (SBEM) 是肝性胸水的一种罕见并发症，其特征为胸水感染而无肺炎。
我们进行这项研究比较了早期胸腔穿刺术（ET）（发病后≤24 小时）和延迟胸腔穿刺术（DT）的 SBEM 患者的临床结局。回顾了 1999 年 1 月 1 日至 2020 年 12 月 31 日在明尼苏达州罗切斯特市梅奥诊所诊断为 SBEM 的所有患者。分析了人口统计学、胸腔积液研究、实验室结果和临床结局。
共发现 54 例 SBEM 患者（27 例 ET 和 27 例 DT），其中 38 例（70.4%）患者表现为右侧胸腔积液。两组患者的基线特征相似。DT 组 ICU 入住率显著较高（15 例[55.6%]与 7 例[25.9%]患者，P=0.027）。DT 组 AKI 发生率相似（11 例[40.7%]与 6 例[22.2%]患者，P=0.074）。住院死亡率（11 例[40.7%]与 2 例[7.4%]患者，P=0.004）、3 个月死亡率（16 例[59.3%]与 2 例[7.4%]患者，P<0.001）和 1 年死亡率（21 例[77.8%]与 6 例[22.2%]患者，P<0.001）在 DT 组较高。
与接受早期胸腔穿刺术的患者相比，发病后 24 小时以上接受胸腔穿刺术（DT）的 SBEM 患者死亡率和 ICU 入住率更高。怀疑 SBEM 时应尽早进行胸腔穿刺术，因为它可能改善生存率。
