Factors Associated with Complicated Parapneumonic Pleural Effusion/Empyema in Patients with Community-Acquired Pneumonia: The EMPIR Study

Objectives: To identify factors associated with complicated parapneumonic pleural effusion/empyema (CPPE/empyema) in inpatients with community-acquired pneumonia (CAP) and to build a mathematical model for CPPE/empyema. Methods: This is an observational case-control study nested within a retrospecti...

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Autores: Jover, RMB, Gil-Guillen, VF, Barba, CP, Quesada, JA, López, MG, Soriano, IG, Pérez, MDP
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p18542
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/18542
Access Level:acceso abierto
Palabra clave:empyema
complicated parapneumonic pleural effusion
community-acquired pneumonia
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spelling Factors Associated with Complicated Parapneumonic Pleural Effusion/Empyema in Patients with Community-Acquired Pneumonia: The EMPIR StudyJover, RMBGil-Guillen, VFBarba, CPQuesada, JALópez, MGSoriano, IGPérez, MDPempyemacomplicated parapneumonic pleural effusioncommunity-acquired pneumoniaObjectives: To identify factors associated with complicated parapneumonic pleural effusion/empyema (CPPE/empyema) in inpatients with community-acquired pneumonia (CAP) and to build a mathematical model for CPPE/empyema. Methods: This is an observational case-control study nested within a retrospective cohort, based on clinical practice, and including adults hospitalized with CAP from 2009 to 2019. Cases and controls were defined according to diagnosis of CPPE/empyema during admission. For each case, two controls were randomly selected and matched for the period of admission to avoid seasonality bias. Explanatory variables included demographic, analytical, clinical, and radiological data; treatment with corticosteroids on admission; prognostic and CAP severity scales; comorbidity; and the interval between symptoms onset and admission. Results: Of 4372 pneumonias reviewed, 2015 were excluded due to pleural effusion, blunting of the costophrenic angle without thoracentesis, or heart failure. Of the remaining 2357 patients, 106 developed CPPE/empyema (cases), and 212 were selected as controls. Factors associated with CPPE/empyema were pleuritic pain (odds ratio [OR] 7.42, 95% confidence interval [CI] 3.83-14.38), multilobar radiological involvement (OR 4.48, 95% CI 2.26-8.88), and leukocytosis (OR 4.12, 95% CI 1.94-8.76). Corticosteroids showed a protective effect (OR 0.24, 95% CI 0.09-0.61). Age (OR 0.99, 95% CI 0.97-1.02; p = 0.56) and sex (OR 1.91, 95% CI 0.94-3.88; p = 0.074) were adjustment variables. The area under the receiver operating characteristic curve was 0.847 (95% CI 0.772-0.921). Conclusions: Pleuritic pain, multilobar radiological involvement, and leukocytosis are associated with CPPE/empyema in inpatients with CAP. Treatment with corticosteroids upon admission seems to be a protective factor. The discriminative capacity of the resulting multivariable model presents moderate/high accuracy.MDPI2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/18542Journal of Clinical MedicineISSN: 20770383reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:fisabio.fundanetsuite.com:p185422026-06-11T12:45:17Z
dc.title.none.fl_str_mv Factors Associated with Complicated Parapneumonic Pleural Effusion/Empyema in Patients with Community-Acquired Pneumonia: The EMPIR Study
title Factors Associated with Complicated Parapneumonic Pleural Effusion/Empyema in Patients with Community-Acquired Pneumonia: The EMPIR Study
spellingShingle Factors Associated with Complicated Parapneumonic Pleural Effusion/Empyema in Patients with Community-Acquired Pneumonia: The EMPIR Study
Jover, RMB
empyema
complicated parapneumonic pleural effusion
community-acquired pneumonia
title_short Factors Associated with Complicated Parapneumonic Pleural Effusion/Empyema in Patients with Community-Acquired Pneumonia: The EMPIR Study
title_full Factors Associated with Complicated Parapneumonic Pleural Effusion/Empyema in Patients with Community-Acquired Pneumonia: The EMPIR Study
title_fullStr Factors Associated with Complicated Parapneumonic Pleural Effusion/Empyema in Patients with Community-Acquired Pneumonia: The EMPIR Study
title_full_unstemmed Factors Associated with Complicated Parapneumonic Pleural Effusion/Empyema in Patients with Community-Acquired Pneumonia: The EMPIR Study
title_sort Factors Associated with Complicated Parapneumonic Pleural Effusion/Empyema in Patients with Community-Acquired Pneumonia: The EMPIR Study
dc.creator.none.fl_str_mv Jover, RMB
Gil-Guillen, VF
Barba, CP
Quesada, JA
López, MG
Soriano, IG
Pérez, MDP
author Jover, RMB
author_facet Jover, RMB
Gil-Guillen, VF
Barba, CP
Quesada, JA
López, MG
Soriano, IG
Pérez, MDP
author_role author
author2 Gil-Guillen, VF
Barba, CP
Quesada, JA
López, MG
Soriano, IG
Pérez, MDP
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv empyema
complicated parapneumonic pleural effusion
community-acquired pneumonia
topic empyema
complicated parapneumonic pleural effusion
community-acquired pneumonia
description Objectives: To identify factors associated with complicated parapneumonic pleural effusion/empyema (CPPE/empyema) in inpatients with community-acquired pneumonia (CAP) and to build a mathematical model for CPPE/empyema. Methods: This is an observational case-control study nested within a retrospective cohort, based on clinical practice, and including adults hospitalized with CAP from 2009 to 2019. Cases and controls were defined according to diagnosis of CPPE/empyema during admission. For each case, two controls were randomly selected and matched for the period of admission to avoid seasonality bias. Explanatory variables included demographic, analytical, clinical, and radiological data; treatment with corticosteroids on admission; prognostic and CAP severity scales; comorbidity; and the interval between symptoms onset and admission. Results: Of 4372 pneumonias reviewed, 2015 were excluded due to pleural effusion, blunting of the costophrenic angle without thoracentesis, or heart failure. Of the remaining 2357 patients, 106 developed CPPE/empyema (cases), and 212 were selected as controls. Factors associated with CPPE/empyema were pleuritic pain (odds ratio [OR] 7.42, 95% confidence interval [CI] 3.83-14.38), multilobar radiological involvement (OR 4.48, 95% CI 2.26-8.88), and leukocytosis (OR 4.12, 95% CI 1.94-8.76). Corticosteroids showed a protective effect (OR 0.24, 95% CI 0.09-0.61). Age (OR 0.99, 95% CI 0.97-1.02; p = 0.56) and sex (OR 1.91, 95% CI 0.94-3.88; p = 0.074) were adjustment variables. The area under the receiver operating characteristic curve was 0.847 (95% CI 0.772-0.921). Conclusions: Pleuritic pain, multilobar radiological involvement, and leukocytosis are associated with CPPE/empyema in inpatients with CAP. Treatment with corticosteroids upon admission seems to be a protective factor. The discriminative capacity of the resulting multivariable model presents moderate/high accuracy.
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/18542
url https://fisabio.portalinvestigacion.com/publicaciones/18542
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv Journal of Clinical Medicine
ISSN: 20770383
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
instname_str Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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