Factors predictive of the failure of medical treatment in patients with pleural infection
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Background/Aims: The clinical outcomes of some patients with pleural infectionmay be favorable with medical treatment alone, but in others, the diseaseprogresses and requires additional surgical treatment. However, little is knownabout the factors affecting this difference. The aim of this study was to investigatethe factors predictive of failure of medical treatment in patients with pleuralinfection. Methods: A cohort of 127 consecutive patients who were admitted to the hospitalwith pleural infection was studied. Clinical manifestations and laboratory findingsin patients in whom medical treatment succeeded or failed were reviewed. Results: In univariate analysis, the significant factors associated with medicaltreatment outcome were age, smoking history, duration of chief complaint, serumalbumin level, and pleural fluid glucose and lactate dehydrogenase levels (p <0.05). Multivariate logistic regression analysis identified age and duration of chief complaintas independent predictive factors for failure of medical treatment, withodds ratios of 0.871 (p = 0.013) and 0.797 (p = 0.026), respectively. Receiver operatingcharacteristic curve analysis determined cutoff values of 50.5 years for age and 4.5days for duration of chief complaint. Conclusions: We demonstrated that a younger age < 50.5 years and shorter durationof chief complaint < 4.5 days were independent predictive factors for thefailure of medical treatment in patients with pleural infection. This suggeststheir role as evaluative criteria in setting indications for the optimal treatment inpatients with pleural infection. A larger, prospective study is required to confirmthese findings.
Abstract
Background/Aims: The clinical outcomes of some patients with pleural infectionmay be favorable with medical treatment alone, but in others, the diseaseprogresses and requires additional surgical treatment. However, little is knownabout the factors affecting this difference. The aim of this study was to investigatethe factors predictive of failure of medical treatment in patients with pleuralinfection. Methods: A cohort of 127 consecutive patients who were admitted to the hospitalwith pleural infection was studied. Clinical manifestations and laboratory findingsin patients in whom medical treatment succeeded or failed were reviewed. Results: In univariate analysis, the significant factors associated with medicaltreatment outcome were age, smoking history, duration of chief complaint, serumalbumin level, and pleural fluid glucose and lactate dehydrogenase levels (p <0.05). Multivariate logistic regression analysis identified age and duration of chief complaintas independent predictive factors for failure of medical treatment, withodds ratios of 0.871 (p = 0.013) and 0.797 (p = 0.026), respectively. Receiver operatingcharacteristic curve analysis determined cutoff values of 50.5 years for age and 4.5days for duration of chief complaint. Conclusions: We demonstrated that a younger age < 50.5 years and shorter durationof chief complaint < 4.5 days were independent predictive factors for thefailure of medical treatment in patients with pleural infection. This suggeststheir role as evaluative criteria in setting indications for the optimal treatment inpatients with pleural infection. A larger, prospective study is required to confirmthese findings.
참고문헌 (25)
- Light RW, "Parapneumonic effusions and empyema", Proc Am Thorac Soc, 3, pp.75~80 (2006)
- Light RW, "Parapneumonic effusions", Am J Med, 69, pp.507~512 (1980)
- Colice GL, "Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline", Chest, 118, pp.1158~1171 (2000)
- Davies HE, "BTS Pleural Disease Guideline Group. Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010", Thorax, 65(Suppl 2), pp.ii41~ii53 (2010)
- Cameron R, "Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema", Cochrane Database Syst Rev, (2), pp.CD002312~ (2008)
- Maskell NA, "U.K. Controlled trial of intrapleural streptokinase for pleural infection", N Engl J Med, 352, pp.865~874 (2005)
- Tokuda Y, "Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis", Chest, 129, pp.783~790 (2006)
- Luh SP, "Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas: outcome of 234 patients", Chest, 127, pp.1427~1432 (2005)
- Petrakis IE, "Video-assisted thoracoscopic surgery for thoracic empyema: primarily, or after fibrinolytic therapy failure?", Am J Surg, 187, pp.471~474 (2004)
- LeMense GP, "Empyema thoracis: therapeutic management and outcome", Chest, 107, pp.1532~1537 (1995)
- Light RW, "A new classification of parapneumonic effusions and empyema", Chest, 108, pp.299~301 (1995)
- Aleman C, "Association between inflammatory mediators and the fibrinolysis system in infectious pleural effusions", Clin Sci (Lond), 105, pp.601~607 (2003)
- Porcel JM, "Tumor necrosis factor-alpha in pleural fluid: a marker of complicated parapneumonic effusions", Chest, 125, pp.160~164 (2004)
- Aderem A, "Toll-like receptors in the induction of the innate immune response", Nature, 406, pp.782~787 (2000)
- Zhang P, "Innate immunity and pulmonary host defense", Immunol Rev, 173, pp.39~51 (2000)
- Gomez CR, "Innate immunity and aging", Exp Gerontol, 43, pp.718~728 (2008)
- Poe RH, "Utility of pleural fluid analysis in predicting tube thoracostomy", decortication in parapneumonic effusions, 1991, pp.100, 963~967
- Sopori ML, "Immunomodulatory effects of cigarette smoke", J Neuroimmunol, 83, pp.148~156 (1998)
- Yanbaeva DG, "Systemic effects of smoking", Chest, 131, pp.1557~1566 (2007)
- Arnson Y, "Effects of tobacco smoke on immunity, inflammation and autoimmunity", J Autoimmun, 34, pp.J258~J265 (2010)
- Gom I, "Relationship between serum albumin level and aging in community-dwelling self-supported elderly population", J Nutr Sci Vitaminol (Tokyo), 53, pp.37~42 (2007)
- Ashbaugh DG, "Empyema thoracis: factors influencing morbidity and mortality", Chest, 99, pp.1162~1165 (1991)
- Cham CW, "Empyema thoracis: a problem with late referral?", Thorax, 48, pp.925~927 (1993)
- Davies CW, "Predictors of outcome and long-term survival in patients with pleural infection", Am J Respir Crit Care Med, 160(5 Pt 1), pp.1682~1687 (1999)
- Huang HC, "Predicting factors for outcome of tube thoracostomy in complicated parapneumonic effusion for empyema", Chest, 115, pp.751~756 (1999)