| Introduction Empyema was first proposed by Hippocrates(460-377 BC),and it was still a clinical disease with high morbidity and mortality.Large,multicentric,randomized trials published by large clinical service institutions confirmed that some factors may affect the occurrence and development of empyema,such as comorbidity,socio-demographic characteristics,treatment regimen,etiology and so on.It was essential to avoid delaying the diagnosis and treatment in order to achieve faster and better recovery and reduce mortality.In recent years,clinical studies mainly focused on the correlation between clinical factors and curative effect,such as surgical methods,antibiotic treatments,susceptible diseases and nosocomial infections and so on.With the improvement of medical level,more and more hospitals can give effective antibiotic and timely drainage treatments to patients with empyema.Further observation and analysis of the clinical characteristics of empyema,and analysis of the factors related to the prognosis of empyema have become the research direction in recent years.Objective To analyze the clinical characteristics of empyema and explore the independent risk factors for poor prognosis and recurrence of empyema after treatment.Methods This was a retrospective study of patients with pleural empyema after effective antibiotic and drainage therapy in department of pulmonary and critical care medicine,Shandong Provincial Hospital Affiliated to Shandong University between January 2011 to December 2017.According to the condition of patients at discharge,the population were classified into non-complete recovery group(N group)and complete recovery group(C group).Comparisons between the two groups were made with the independent-samples T test for continuous variables and χ2 test for categorical variables,if the data follow the law of normal distribution.Otherwise,the rank sum test was used for Mann-Whitney U test.Univariate/Multivariate analyses for outcome was used logistic regression.P<0.05 was considered statistically significant for each analysis.Odds ratios(ORs)and 95%CI(confidence intervals)represented the relative risks,the above statistical analysis was performed using the SPSS statistical software package(IBM SPSS statistics for windows,Version 20)Results There were no significant differences in age,gender composition ratio,BMI(Body Mass Index),habitat,the location of empyema between the two groups(all P>0.05).Most patients in the N group had a history of smoking(62.5%),but the difference between the two groups was not statistically significant.The difference in alcoholism between the two groups was statistically significant(P=0.031),and the composition of alcoholism in N group was relatively large.In terms of initial symptoms of empyema,cough,dyspnea,fever and chest pain showed no statistically significant differences between the two groups(all P>0.05).In terms of co-morbidity,there was no statistically significant differences in digestive system diseases,nervous system diseases,heart diseases and respiratory system diseases between the two groups(all P>0.05).The proportion of comorbidity diabetes in group N was higher than that in group C,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups in the location and appearance of the empyema(all P>0.05),and most of them were located in the right thoracic cavity.There were 12 cases of positive bacterial culture in the two groups,including 4 cases in N group(16.0%)and 8 cases in C group(18.6%),with no statistically significant difference between the two groups(P=1.000).The mean LOS(Length of stay)and duration of effective antibiotic treatment of the N group were(12±5)days and(9.5(7.25,12.75))days,respectively,while of the C group were(15(11,21))days and(12(10,15.5))days,and the differences between the two groups were statistically significant(all P<0.05).The recurrence of empyema within 1 month in N group(8 cases,25.0%)was more than that in C group(4 cases,8.2%),and the difference between groups was not statistically significant(P=0.054).No-complete recovery at discharge was positively correlated with alcoholism.、DM,and negatively correlated with length of stay and duration of effective antibiotic treatment(all P<0.05).Recurrence within 1 month was positively correlated with alcoholism and no-complete recovery at discharge,and negatively correlated with length of stay and duration of effective antibiotic treatment(all P<0.05).Multiple logistic regression analysis showed that alcoholism(OR=2.904,95%CI:1.064-7.929,P=0.037),and DM(OR=3.121,95%CI:1.098-10.184,P=0.043)were correlated to insufficient recovery outcome at discharge.AS for the recurrence of empyema within 1 month.,alcoholism was the risk factor(OR=4.009,95%CI:1.014-15.845,P=0.048).However,no-complete recovery of empyema was not the risk factor for recurrence of empyema within 1 month(OR=2.059,95%CI:0.493-8.600,P=0.322).Conclusions1.Most of the patients with empyema were middle-aged and elderly people,and most of them were male and obese.The patients with empyema had certain regional differences,most of which were located in the right thoracic cavity,the vast majority of whom were located in the rural areas where the economy was relatively backward.Cough and chest pain were the common initial symptoms.2.Patients with non-complete recovery of empyema at discharge often have a history of alcoholism,and the proportion of patients with total diabetes is higher than that of patients with complete recovery of empyema at discharge,and the recurrence of empyema within 1 month is higher than that of patients with complete recovery of empyema;3.After effective antibiotics and drainage treatment,alcoholism was not only an independent risk factor for poor prognosis of patients with empyema at discharge,but also a risk factor for recurrence of empyema within 1 month.However,No-complete recovery of empyema was not the risk factor for recurrence of empyema within 1 month. |
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