Epidemiology and prognostic factors of pleural empyema

Abstract

BackgroundInfection of the pleural cavity invariably leads to hospitalisation, and a fatal outcome is not uncommon. Our aim was to study the epidemiology of pleural empyema on a nationwide basis in the whole population and in three subgroups of patients, namely post-lung resection, associated cancer and those with no surgery and no cancer.MethodsData from patients aged ≥18 years hospitalised with a diagnosis of pleural infection in France between January 2013 and December 2017 were retrieved from the medical-administrative national hospitalisation database and retrospectively analysed. Mortality, length of stay and costs were assessed.ResultsThere were 25 512 hospitalisations for pleural empyema. The annual rate was 7.15 cases per 100 000 habitants in 2013 and increased to 7.75 cases per 100 000 inhabitants in 2017. The mean age of patients was 62.4±15.6 years and 71.7% were men. Post-lung resection, associated cancer and no surgery–no cancer cases accounted for 9.8%, 30.1% and 60.1% of patients, respectively. These groups were significantly different in terms of clinical characteristics, mortality and risk factors for length of stay, costs and mortality. Mortality was 17.1% in the whole population, 29.5% in the associated cancer group, 17.7% in the post-lung resection group and 10.7% in the no surgery–no cancer group. In the whole population, age, presence of fistula, higher Charlson Comorbidity Index (>3), alcohol abuse, arterial hypertension, hyperlipidaemia, atheroma, atrial fibrillation, performance status >3 and three subgroups of pleural empyema independently predicted mortality.ConclusionsEmpyema is increasing in incidence. Factors associated with mortality are recent lung resection and associated diagnosis of cancer.

Recent Insights into the Management of Pleural Infection

“…The incidence of pleural infection nearly doubled from the first to the second decade of the 21st century. 11,12,14 In Europe, the US, Canada, and Australia, 5,6,8,13,14,16 the average age of patients diagnosed with pleural infection is 58-63 years. However, a recent systematic review pointed out a discrepancy in the age bracket of adult patients with pleural infection between high-income and low(er)-income countries, where patients in the latter group tended to be 15 years younger on average.…”

“…Epidemiological studies from North America, 11 , 12 Western Europe, 13 , 14 and East Asia 15 have shown that incidence of pleural infection in the second decade of the 21st century is 6.7–9.9 cases per 100,000 population. The incidence of pleural infection nearly doubled from the first to the second decade of the 21st century.…”

Psychoanalysis of the Doctrine of Acute Pneumonia

“…The dominant ideas about circulatory disorders in patients with AP are in contradiction with the fundamental research on the role of the lungs in the vital activity of this system. The influence of the focus of inflammation on this function of the organ is replaced by the concept of the dependence of these disorders on the action of the infectious factor [30,31,[35][36][37][38][39]. Such concepts suggest the wrong direction of therapeutic efforts, which may not bring the expected effect.…”

“…Now comes the viral season in the etiology of AP, but the search for optimal treatment options continues on the basis of previous conceptual views on this disease. The purpose of such studies is to study the features of COVID-19 pneumonia based on the properties of the coronavirus and the expected consequences of its aggression [30,31,[35][36][37][38][39]. At the same time, inflammation of the lung tissue, which is a distinctive characteristic of the disease and determines the originality and severity of its course, is considered as a sign, and not its basis.…”

Psychoanalysis of the doctrine of acute pneumonia

“…The current results of AP treatment fully correspond to the narrowed ideas about the nature of the disease and the principles of medical care. From this point of view, a further increase in the frequency of pleural empyema in the last decade is quite natural, especially since AP, as the main cause of this purulent complication, remains without a detailed analysis [41,42]. Now comes the viral season in the etiology of AP, but the search for optimal treatment options continues on the basis of previous conceptual views on this disease.…”