Outcomes of Adult Empyema Thoracis Cases Managed in a Tertiary Hospital in Uganda: a Retrospective Cohort Study

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Iranya, John Paul Magala, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6579182/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Aug, 2025 Read the published version in BMC Pulmonary Medicine → Version 1 posted 12 You are reading this latest preprint version Abstract Background: Empyema thoracis is a debilitating illness observed in all age groups. Recent data indicate increasing incidence rates and worsening outcomes. However, published data on the outcomes of empyema thoracis cases in our setting are scarce. Objective: This study evaluated outcomes and associated factors for adult empyema thoracis patientsmanaged at a single tertiary center in Uganda. Methods : We reviewed the file records of patients 18 years or older who were managed for empyema thoracis at Mulago National Referral Hospital from January 2017 to December 2021. Sociodemographic data, comorbidities, clinical parameters at admission, and management strategies were reviewed. The outcomes of interest were in-hospital mortality and the need for reintervention. A multivariate logistic regression model was used to identify independent factors associated with the need for reintervention and in-hospital mortality. Results: A total of 200 case files were analyzed, and 123 (61.5%) of the cases were males. The median age of the cohort was 33 years (IQR=21). The in-hospital mortality rate was 10.5% (21 patients), and 23.5% (47 patients) required one or more reinterventions. Advancing age (adjusted OR=1.04 (1.01–1.08)) and nonparapneumonicunderlying etiology (adjusted OR=11.45 (2.74–47.89)) were independently associated with increased in-hospital mortality, whereas delayed empyema drainage (adjusted OR=2.97 (1.33–6.67)) and underlying nonparapneumonic etiology (adjusted OR=3.83 (1.45–10.10.10)) significantly increased the odds of the need for reintervention in management. Conclusion: The in-hospital mortality and reintervention rates for empyema thoracis were high in our study. Particularly at-risk groups for these poor outcomes are those with advanced age, nonparapneumonic empyema thoraces, and delayed initial intervention. Empyema thoracis outcomes in-hospital mortality and reintervention. Introduction Empyema thoracis is a disease that has been present since antiquity but continues to be an important healthcare problem with unacceptably high morbidity and mortality rates worldwide. To date, a mortality rate of 10–20% has been reported globally despite advances in management techniques over the years [1-3]. Recently, the incidence and mortality of adult empyema thoracis have shown an increasing trend [4 5], probably due to the aging population and prevalent comorbid conditions, especially in Western countries [2 4 6]. The common underlying etiology for empyema thoracis is an extension of a bronchopulmonary infection into the pleural space (parapneumonic effusion), accounting for up to 70% of cases [4 7]. Other underlying causes include bronchogenic carcinoma, esophageal rupture, blunt or penetrating chest trauma, and extensions of infections in the mediastinum, head and neck fascial spaces and the infradiaphragmatic region. In sub-Saharan Africa and other tropical regions, tuberculosis and parasitic infections remain important causes of empyema thoracis [7] The standard of care for empyema thoracis includes prompt control of the infectious source through appropriate antimicrobial therapy, pleural pus drainage, and full re-expansion of the lungs [8 9]. The pleural pus drainage strategy is dictated by the stage of the empyema (Davies, Davies, & Davies, 2010; Feller-Kopman & Light, 2018); tube thoracostomy drainage with or without intrapleural fibrinolytics has been recommended for early-stage empyema with video-assisted thoracoscopic surgery (VATS) and/or open thoracotomy reserved for late stages of the disease [9 10]. Managing Empyema thoracis is a challenge in Sub-Saharan Africa, where most patients present late to care; often with late stages of disease yet, centers capable of providing surgical management options (i.e., VATS and open thoracotomy) are few and inaccessible to many in the region [3 11 12]. In Uganda, published literature on the treatment outcomes for empyema thoracis remains scarce. Our study aimed to evaluate the treatment outcomes and associated factors in patients with empyema thoracis. We believe this will guide treatment protocols for improved outcomes as well as facilitating the efficient use of scarce resources. Methods and materials This was a retrospective cohort study conducted at Mulago Hospital, one of the National Referral Hospitals in Uganda, and a teaching center for Makerere University College of Health Sciences. File records of adult patients (18 years or older) with a diagnosis of empyema thoracis managed over a period of 5 years from January 2017 to December 2021 were retrieved for data extraction. A case of empyema thoracis was defined as pleural infection diagnosed by any one of the following criteria: (1) pleural fluid that was macroscopically purulent, (2) positive on bacterial culture and/or Gram staining, or (3) pleural fluid that had a pH of < 7.2. Patients who were discharged against medical advice and lost to follow-up whose final treatment outcomes were not documented in the file were excluded. Reintervention was defined as any need for chest tube reinsertion and/or surgical intervention (open thoracotomy or VATS) following failed initial intervention. In-hospital mortality was any death occurring during the hospital stay due to complications related to empyema thoraces and their management. We used a consecutive sampling technique based on the admission date to select eligible patient files. The sample size was estimated via the Fleiss method with a continuity correction factor [13]. Given a confidence level of 95%, a study power of 80% with a 1:1 ratio of exposed to nonexposed groups, and data from a previous study that reported empyema thoracis mortality rates of 17% and 47% among the nonexposed group (comunity-acquired empyema) and exposed group (hospital-acquired empyema thoracis), the minimum sample size for this study, adjusted upward by 20% to factor in loss to follow-up and/or incomplete data, was 106 cases. Data collection procedure We used a pretested semistructured tool to extract data from patient files. The data included were sociodemographic data (age, sex), comorbidities (cardiac diseases, diabetes mellitus, current or previous malignancy, chronic liver disease, HIV/AIDS, and chronic renal diseases), clinical parameters at admission (hospital or community acquired empyema thoraces, and the underlying etiology), management parameters (delay >3 days from the time of diagnosis to initial intervention), and surgical data (Video Assisted Thoracoscopy or open thoracotomy) versus nonsurgical management. The outcomes of interest were reintervention and in-hospital mortality. Data management and analysis. The data were entered into Microsoft Excel, cleaned and then exported to STATA version 18 (STATA Corp, College Station, Texas) for analysis. Using descriptive statistics, continuous nonnormally distributed variables, namely, age and length of hospital stay, were summarized as medians and interquartile ranges (IQRs). Categorical variables are summarized as proportions (percentages) and absolute frequencies. Univariable and multivariable logistic regression models were fitted to identify variables independently associated with the need for reintervention and in-hospital mortality. Only variables with p values < 0.2 in the univariable models were included in the multivariable analyses. The final parsimonious model for each outcome (i.e., in-hospital mortality and reintervention) was chosen on the basis of the lowest value for the Akaike information criterion (AIC). All analyses were two sided (p<0.05). The results are reported as odds ratios (ORs) and 95% confidence intervals (CIs). Results Baseline characteristics. A total of 200 case files were analyzed. One hundred and twenty-three (61.5%) of the patients were males. The median age of the patients was 33 years (IQR = 21). Seventy-one patients (35.5%) had at least one of the comorbidities (cardiovascular disease, diabetes mellitus, chronic liver disease, chronic kidney disease, HIV/AIDS, current or previous malignancy and malnutrition); however, none of these patients had 2 or more concurrent comorbidities. There were 155 (77.5%) community-acquired empyema thoraces cases and 45 (22.5%) hospital-acquired cases. The underlying etiology for empyema thoracis was complicated parapneumonic effusion in 161 patients (80.5%). Other underlying etiologies included complications of thoracic trauma in 16 patients (8.0%), tuberculosis empyema in 13 patients (6.5%), malignancy in 5 patients (2.5%), and extension of the head and neck or infradiaphragmatic infections in 5 patients (2.5%). All of the patients (100%) evaluated underwent tube thoracostomy as the initial pleural drainage modality (Table 1 ) . Table 1 Baseline chararcteristic of empyema thoracis cases. Total In-hospital mortality Need for re-intervention Parameter Frequency n (%) Died (n = 21) Alive (n = 179) p-value No (n = 153) Yes (n = 47) p-value Age (years) 33 (26–47) 45 (35–56) 32 (24–45) 0.002 33 (24–44) 36 (28–53) 0.132 Sex 0.355 0.498 Male 123 (61.5) 15 (12.2) 108 (87.8) 92 (74.8) 31 (25.2) Female 77 (38.5) 6 (7.8) 71 (92.2) 61 (79.2) 16 (20.8) Alcohol intake 0.141 0.001 Yes 65 (32.5) 10 (15.4) 55 (84.6) 40 (61.5) 25 (38.5) No 135 (67.5) 11 (8.1) 124 (91.9) 113 (83.7) 22 (16.3) Comorbidity 0.419 0.863 No 129 (64.5) 10 (7.9) 117 (92.1) 98 (77.2) 29 (22.8) Yes 71 (35.5) 11 (15.1) 62 (84.9) 55 (75.3) 18 (24.7) Category of empyema thoraces 0.010 0.844 Community-acquired 155 (77.5) 11 (7.1) 144 (92.9) 119 (76.8) 36 (23.2) Hospital-acquired 45 (22.5) 10 (22.2) 35 (77.8) 34 (75.6) 11 (24.4) etiology of empyema thoraces < 0.001 < 0.001 Para-pneumonic 161 (80.5) 7 (4.3) 154 (95.7) 137 (85.1) 24 (14.9) Others b 39 (19.5) 14 (35.9) 25 (64.1) 16 (41.0) 23 (59.0) Delayed treatment 0.006 < 0.001 No 133 (66.5) 8 (6.0) 125 (94.0) 116 (87.2) 17 (12.8) yes 67 (33.5) 13 (19.4) 54 (80.6) 37 (55.2) 30 (44.8) Initial pleural drainage Chest tube drainage 200 (100) 21 (10.5) 179 ( 89.5) - 153 (66.6) 47 (33.3) - VATS 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Open thoracotomy 0 (0.0) 0 (0.0) 0 (0.0) 0(0.0) 0 (0.0) IQR; Inter-quartile range, b; empyema arising from complications of thoracic trauma, tuberculosis, malignancy, or extension of head/neck infections, VATS; Video Assisted Thoracoscopy. Outcomes of empyema thoracis management. The reintervention rate in this cohort was 23.5% (95% CI: 17.8–30.0%) (47 patients). Among the patients who required reintervention, 37 (78.7%) underwent a second chest tube insertion, whereas 10 (21.3%) underwent open decortication. The in-hospital mortality rate was 10.5% (95% CI: 6.6% − 15.6%) (21 patients). The median length of hospital stay in this cohort was 19 days (IQR = 8.3). Factors associated with in-hospital mortality and reintervention Multivariate analysis revealed that advanced age and the nonparapneumonic underlying etiology of empyema were significantly associated with an increased risk of in-hospital mortality. The odds of dying from empyema thoracis increased by 4% per year increase in age (adjusted OR: 1.04, 95% CI: 1.01–1.08). Similarly, the in-hospital mortality of empyema thoraces from underlying causes other than parapneumonic effusion was more than 11 times greater than that of parapneumonic empyema thoracis (adjusted OR = 11.45, 95% CI: 2.74–47.89) (Table 2 ) . Table 2 Univariable and multivaraible analysis of factors associated with in-hospital mortality following empyema thoracis management. Univariable analysis Multivariable analysis Parameter Crude OR 95% CI p-value Adjusted OR 95% CI p-value Age (years) ) 1.06 1.03–1.09 < 0.001 1.04 1.01–1.08 0.001* Sex Female 1 - - - Male 1.64 0.64–4.43 0.327 - - - Alcohol intake Yes 1 1 No 0.49 0.19–1.20 0.124 2.02 0.51–8.10 0.319 Comorbidity No 1 - - - Yes 2.07 0.83–5.16) 0.116 - - - Category of empyema thoraces Community-acquired 1 1 Hospital-acquired 3.74 1.47–9.51 0.006 2.21 0.73–6.66 0.159 Etiology of empyema thoraces Para-pneumonic empyema 1 1 Others b 12.32 4.53–33.51 < 0.001 11.45 2.74–47.89 < 0.001* Delayed treatment No 1 1 yes 3.76 1.47–9.60 0.006 1.35 0.39–4.73 0.635 *; statistically significant factors at p < 0.05, OR; Odds ratio, CI; Confidence Interval. Table 3 summarizes the univariable and multivariable logistic regression analyses of factors associated with reintervention following initial management of empyema thoraces at our center. The statistically significant factors associated with increased reintervention rates in the multivariate analysis were nonparapneumonic etiology (adjusted OR = 3.83, 95% CI: 1.45–10.10) and a delay of more than 3 days (from diagnosis) to drainage of empyema thoraces (adjusted OR = 2.97, 95% CI: 1.33–6.67). Table 3 Univariable and multivaraible analysis of factors associated with need for re-intervention following initial empyema thoracis management. Univariable analysis Multivariable analysis Parameter Crude OR 95% CI p-value adjusted OR 95% CI p-value Age (years) ) 1.02 0.99–1.04 0.123 1.01 0.98–1.03 0.580 Sex Female 1 - - - Male 1.28 0.65–2.55 0.473 - - - Alcohol intake Yes 1 1 No 0.31 0.12–0.61 < 0.001 0.71 0.31–1.65 0.428 Comorbidity No 1 - - - Yes 1.11 0.56–2.17 0.768 - - - Category of empyema thoraces Community-acquired 1 - - - Hospital-acquired 1.07 0.49–2.32 0.864 - - - Cause of empyema thoraces Para-pneumonic empyema 1 1 Others b 8.21 3.79–17.75 < 0.001 3.83 1.45–10.10 0.007* Delayed treatment No 1 1 yes 5.53 2.75–11.15 < 0.001 2.97 1.33–6.67 0.008* *; statistically significant factors at p < 0.05, OR; Odds Ratio, CI; Confidence Interval. Discussion In this retrospective cohort study, we evaluated the outcomes and associated factors for empyema thoracis cases managed at a single tertiary hospital in Uganda. Our study provides important insights into the local burden and management outcomes of this often debilitating condition. In-hospital mortality of empyema thoracis We found an overall in-hospital mortality rate of 10.5% in our cohort, a figure that is still high, albeit within the ranges reported in studies by other authors [14 15]. While the high mortality of empyema thoracis, especially in the developed world, is often attributed to prevalent comorbidities and the aging population [2 4 16], this is not the case in this cohort, which is relatively young and has relatively few comorbidities. The high mortality in our setting may be related to delayed diagnosis and possibly other healthcare system deficiencies. We also noted that increasing age was associated with a greater risk of in-hospital mortality in patients with empyema thoracis. Several related studies have also noted this association [ 8 17 – 19 ]. This finding aligns with the fact that older patients may have diminished physiological reserves, comorbidities, and delayed presentations due to atypical empyema thoracis features, all of which can adversely affect outcomes. Previous studies have shown that the number rather than the presence of a single comorbidity is a risk factor for increased mortality in patients with empyema thoracis [1 7 20]. Mitchell and colleagues evaluated the associations between patient comorbidities and clinical outcomes in a large database of hospitalized empyema thoracis cases in the United States (USA). They reported that mortality was not significantly associated with individual comorbidities and that severe cases with 3 or more comorbidities were significantly associated with mortality in patients with empyema thoracis[ 1 ]. Our finding of no significant association between comorbidities and in-hospital mortality agrees with their findings, given that none of our patients had 2 or more comorbidities. Interestingly, this study revealed that empyema thoracis cases secondary to parapneumonic effusions are associated with a significantly lower in-hospital mortality rate than those arising from other causes, such as tuberculosis, trauma, malignancy and extension of the head and neck or infra-diaphragmatic infections. This may reflect the relatively better prognosis of parapneumonic empyema when diagnosed early and treated aggressively with antibiotics and prompt pleural drainage and the fact that most of the other underlying causes are often associated with poor prognostic factors, such as malnutrition and general debilitation [7 8 15 17]. Re-intervention rate in empyema thoracis treatment. The rate of reintervention following treatment for patients with empyema thoracis in our study was high (23.5%). Comparable reintervention rates have been noted in other studies [14 20 21]. One key observation in all these studies is that most of the cases evaluated had a late stage of empyema. Although the stage of empyema thoraces was not recorded for most of the patients in our cohort, we noted a significant association of reintervention rates with delays of more than 3 days to drain the empyema, most likely indicating late-stage treatment. An additional reason for the high reintervention rates in our study could be that all our cases were initially managed with chest tube drainage; previous studies have shown high failure rates for this empyema thoracis treatment modality, especially for late-stage empyema [14 20 22]. Our study revealed that patients with empyema thoracis with underlying causes other than parapneumonic effusion had a significantly higher reintervention rate. This finding agrees with several other related series [5 9 23]. Empyema, caused by entities such as malignant effusion and infection extending from the head/neck, can lead to the accumulation of pus in the chest, leading to the need for a longer drainage period and often the need for reintervention. Moreover, these conditions are often associated with malnutrition and overall low immunity; hence, patients are highly likely to have severe or recurrent empyema requiring reintervention. Study limitations. This study has inherent limitations due to its retrospective database design, including possibilities of selection bias and missing or incomplete data, e.g., most of the case files did not have microbiologic culture data, which we believe would have been valuable for examining its impact on the outcomes of empyema thoracis. Conclusions These studies revealed high in-hospital mortality and reintervention rates for empyema thoracis cases managed at our center, with delayed initial intervention, advanced age and nonparapneumonic etiology of empyema being the major factors associated with increased likelihood of reintervention and/or in-hospital mortality. Taken together, our findings underscore the need for early diagnosis and timely intervention in the management of empyema thoracis. Special attention should be given to elderly patients who are at increased risk of mortality, and targeted strategies may be needed for nonparapneumonic causes, which appear to have poorer outcomes. Abbreviations HIV/AIDS Human immunodeficiency virus/acquired immunodeficiency syndrome IQR Interquartile range OR odds ratio UNCST Uganda National Council of Science and Technology SOMREC School of Medicine Research Ethics Committee of Makerere University VATS Video-assisted thoracoscopic surgery Declarations Consent for publication: Not applicable. Ethical approval : This study was conducted in accordance with the Helsinki declaration of ethical principles of medical research involving human subjects. The approval to conduct the study was granted by ‘School of Medicine Research and Ethics Committee of Makerere University’ (SOMREC) (Ethical approval number: Mak-SOMREC-2022-417). Consent to participate. This being a medical- record based retrospective study, obtaining informed consent to participate from each patient was not practically feasible due to missing contact information. We sought & obtained waiver of consent to participate from the Research Ethics Committee of the School of Medicine, Makerere University (SOMREC). Clinical trial number: Not applicable. Data availability : The primary data for this study are available from the corresponding author on reasonable request. Conflicts of interest : The authors declare that they have no conflicts of interest. Funding Statement: This study did not receive any external funding. Author contribution : MM was the principal investigator and contributed to conceptualization, drafting of the proposal, data collection, and manuscript draft. RNI performed the statistical analysis, discussed the results, and participated in the drafting of the manuscript. OP contributed to the drafting of the manuscript. JPM and TKM supervised the study. All authors participated in editing and proofreading the final manuscript. Acknowledgment. We acknowledge the contribution of the staffs of the Department of Surgery, Makerere University College of Health Sciences, and Surgical unit of Mulago National Referral Hospital in ensuring a smooth and orderly data collection process. Authors’ information. MM: G eneral Surgeon, Department of Surgery, International Hospital Kampala (IHK), Uganda. E-mail address; [email protected] OP : Lecturer, Department of Surgery, Soroti University, Soroti District, Uganda. E-mail; [email protected] RNI : Associate consultant surgeon, Department of Surgery, Moyo General Hospital, Moyo district, Uganda. E-mail address; [email protected] JPM: Lecturer, Department of Surgery, School of medicine, college of health science, Makerere University, Kampala, Uganda. E-mail address: [email protected] TKM : Senior lecturer, Department of Surgery, School of medicine, college of health science, Makerere University, Kampala, Uganda. 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The Journal of thoracic and cardiovascular surgery 2017; 153 (6):e129-e46 Tables Tables 1 to 3 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Empyemamanscripttables..docx Cite Share Download PDF Status: Published Journal Publication published 01 Aug, 2025 Read the published version in BMC Pulmonary Medicine → Version 1 posted Editorial decision: Revision requested 16 Jun, 2025 Reviews received at journal 15 Jun, 2025 Reviewers agreed at journal 15 Jun, 2025 Reviews received at journal 06 Jun, 2025 Reviewers agreed at journal 02 Jun, 2025 Reviewers agreed at journal 14 May, 2025 Reviewers agreed at journal 09 May, 2025 Reviewers invited by journal 09 May, 2025 Editor invited by journal 08 May, 2025 Editor assigned by journal 07 May, 2025 Submission checks completed at journal 07 May, 2025 First submitted to journal 02 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6579182","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":454846132,"identity":"52924942-381f-4658-9496-72211c52883b","order_by":0,"name":"Michael Mwesige","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Mwesige","suffix":""},{"id":454846133,"identity":"ac05fa81-0109-4824-a508-5b882d574155","order_by":1,"name":"Paul Otim","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"Otim","suffix":""},{"id":454846134,"identity":"436d05ed-e98a-4c44-a14c-6fb8c12e2bd4","order_by":2,"name":"Richard N. Iranya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYFACxgYwxc8Oog0sSNAi2XMApEWCBMsMbiSAKCK0mDcwt334ueOwvMHN51c3/CiQYOBv707Aq0XmAGPzzN4zhw1n3s4pu9kDdJjEmbMb8GqRYGBsZuBtO8zYdzsn7QYPUIuBRC5hLYx/2w7bN9w8k3bzD7FamIG2JE64wX7sNnG2MAO1yLalJ8/syWG7LWMgwUPYL+ztjxnftlnb9rMff3bzzR8bOf72XvxaGJjBZDMQ8xiAWDz4lSNAHRCzPyBW9SgYBaNgFIwwAABa+0ZJsBkXbwAAAABJRU5ErkJggg==","orcid":"","institution":"Moyo General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Richard","middleName":"N.","lastName":"Iranya","suffix":""},{"id":454846135,"identity":"a16fb4b6-57ab-43f2-baa2-d7e0266bd622","order_by":3,"name":"John Paul Magala","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"Paul","lastName":"Magala","suffix":""},{"id":454846136,"identity":"60dfe8bc-827c-4d5b-aed2-53c5b7e1dc27","order_by":4,"name":"Timothy K. Makumbi","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Timothy","middleName":"K.","lastName":"Makumbi","suffix":""}],"badges":[],"createdAt":"2025-05-02 14:38:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6579182/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6579182/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12890-025-03861-0","type":"published","date":"2025-08-01T16:38:04+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88268880,"identity":"f0dd6978-fb53-4a50-8392-71b2de435623","added_by":"auto","created_at":"2025-08-04 16:52:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":952969,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6579182/v1/2b06779d-f098-4056-b013-df496df16994.pdf"},{"id":82696761,"identity":"b92f33ed-c472-4086-9075-161d54036c1d","added_by":"auto","created_at":"2025-05-14 08:54:14","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22997,"visible":true,"origin":"","legend":"","description":"","filename":"Empyemamanscripttables..docx","url":"https://assets-eu.researchsquare.com/files/rs-6579182/v1/e95d64b2d8a0d148b1422741.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eOutcomes of Adult Empyema Thoracis Cases Managed in a Tertiary Hospital in Uganda: a Retrospective Cohort Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEmpyema thoracis is a disease that has been present since antiquity but continues to be an important healthcare problem with unacceptably high morbidity and mortality rates worldwide. To date, a mortality rate of 10\u0026ndash;20% has been reported globally despite advances in management techniques over the years [1-3]. Recently, the incidence and mortality of adult empyema thoracis have shown an increasing trend [4 5], probably due to the aging population and prevalent comorbid conditions, especially in Western countries [2 4 6].\u003c/p\u003e\n\u003cp\u003eThe common underlying etiology for empyema thoracis is an extension of a bronchopulmonary infection into the pleural space (parapneumonic effusion), accounting for up to 70% of cases [4 7]. Other underlying causes include bronchogenic carcinoma, esophageal rupture, blunt or penetrating chest trauma, and extensions of infections in the mediastinum, head and neck fascial spaces and the infradiaphragmatic region. In sub-Saharan Africa and other tropical regions, tuberculosis and parasitic infections remain important causes of empyema thoracis [7]\u003c/p\u003e\n\u003cp\u003eThe standard of care for empyema thoracis includes prompt control of the infectious source through appropriate antimicrobial therapy, pleural pus drainage, and full re-expansion of the lungs [8 9]. The pleural pus drainage strategy is dictated by the stage of the empyema (Davies, Davies, \u0026amp;amp; Davies, 2010; Feller-Kopman \u0026amp;amp; Light, 2018); tube thoracostomy drainage with or without intrapleural fibrinolytics has been recommended for early-stage empyema with video-assisted thoracoscopic surgery (VATS) and/or open thoracotomy reserved for late stages of the disease [9 10].\u003c/p\u003e\n\u003cp\u003eManaging Empyema thoracis is a challenge in Sub-Saharan Africa, where most patients present late to care; often with late stages of disease yet, centers capable of providing surgical management options (i.e., VATS and open thoracotomy) are few and inaccessible to many in the region [3 11 12].\u003c/p\u003e\n\u003cp\u003eIn Uganda, published literature on the treatment outcomes for empyema thoracis remains scarce. Our study aimed to evaluate the treatment outcomes and associated factors in patients with empyema thoracis. We believe this will guide treatment protocols for improved outcomes as well as facilitating the efficient use of scarce resources.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cp\u003eThis was a retrospective cohort study conducted at Mulago Hospital, one of the National Referral Hospitals in Uganda, and a teaching center for Makerere University College of Health Sciences. File records of adult patients (18 years or older) with a diagnosis of empyema thoracis managed over a period of 5 years from January 2017 to December 2021 were retrieved for data extraction. A case of empyema thoracis was defined as pleural infection diagnosed by any one of the following criteria: (1) pleural fluid that was macroscopically purulent, (2) positive on bacterial culture and/or Gram staining, or (3) pleural fluid that had a pH of \u0026lt; 7.2.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ePatients who\u0026nbsp;were discharged against medical advice and\u0026nbsp;lost\u0026nbsp;to follow-up whose final treatment outcomes\u0026nbsp;were\u0026nbsp;not documented in the file\u0026nbsp;were excluded. Reintervention\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ewas defined as any need for chest tube\u0026nbsp;reinsertion\u0026nbsp;and/or surgical intervention (open thoracotomy or VATS) following failed initial intervention. In-hospital mortality was any death occurring during the hospital stay due to complications related to empyema thoraces and\u0026nbsp;their\u0026nbsp;management.\u003c/p\u003e\n\u003cp\u003eWe used a consecutive sampling technique based on the admission date to select eligible patient files. The sample size was estimated via the Fleiss method with a continuity correction factor [13]. Given a confidence level of 95%, a study power of 80% with a 1:1 ratio of exposed to nonexposed groups, and data from a previous study that reported empyema thoracis mortality rates of 17% and 47% among the nonexposed group (comunity-acquired empyema) and exposed group (hospital-acquired empyema thoracis), the minimum sample size for this study, adjusted upward by 20% to factor in loss to follow-up and/or incomplete data, was 106 cases.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData collection procedure\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe used a pretested semistructured tool to extract data from patient files. The data included were sociodemographic data (age, sex), comorbidities (cardiac diseases, diabetes mellitus, current or previous malignancy, chronic liver disease, HIV/AIDS, and chronic renal diseases), clinical parameters at admission (hospital or community acquired empyema thoraces, and the underlying etiology), management parameters (delay \u0026gt;3 days from the time of diagnosis to initial intervention), and surgical data (Video Assisted Thoracoscopy or open thoracotomy) versus nonsurgical management. The outcomes of interest were reintervention and in-hospital mortality.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData management and analysis.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data were entered into Microsoft Excel, cleaned and then exported to STATA version 18 (STATA Corp, College Station, Texas) for analysis. Using descriptive statistics, continuous nonnormally distributed variables, namely, age and length of hospital stay, were summarized as medians and interquartile ranges (IQRs). Categorical variables are summarized as proportions (percentages) and absolute frequencies.\u003c/p\u003e\n\u003cp\u003eUnivariable and multivariable logistic regression models were fitted to identify variables independently associated with the need for reintervention and in-hospital mortality. Only variables with p values \u0026lt; 0.2 in the univariable models were included in the multivariable analyses. The final parsimonious model for each outcome (i.e., in-hospital mortality and reintervention) was chosen on the basis of the lowest value for the Akaike information criterion (AIC). All analyses were two sided (p\u0026lt;0.05). The results are reported as odds ratios (ORs) and 95% confidence intervals (CIs).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cem\u003eBaseline characteristics.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA total of 200 case files were analyzed. One hundred and twenty-three (61.5%) of the patients were males. The median age of the patients was 33 years (IQR\u0026thinsp;=\u0026thinsp;21). Seventy-one patients (35.5%) had at least one of the comorbidities (cardiovascular disease, diabetes mellitus, chronic liver disease, chronic kidney disease, HIV/AIDS, current or previous malignancy and malnutrition); however, none of these patients had 2 or more concurrent comorbidities. There were 155 (77.5%) community-acquired empyema thoraces cases and 45 (22.5%) hospital-acquired cases. The underlying etiology for empyema thoracis was complicated parapneumonic effusion in 161 patients (80.5%). Other underlying etiologies included complications of thoracic trauma in 16 patients (8.0%), tuberculosis empyema in 13 patients (6.5%), malignancy in 5 patients (2.5%), and extension of the head and neck or infradiaphragmatic infections in 5 patients (2.5%). All of the patients (100%) evaluated underwent tube thoracostomy as the initial pleural drainage modality (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline chararcteristic of empyema thoracis cases.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eIn-hospital mortality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNeed for re-intervention\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParameter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDied (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAlive (n\u0026thinsp;=\u0026thinsp;179)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;153)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (26\u0026ndash;47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (35\u0026ndash;56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (24\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33 (24\u0026ndash;44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36 (28\u0026ndash;53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123 (61.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108 (87.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e92 (74.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31 (25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (92.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61 (79.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (84.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 (61.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135 (67.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e124 (91.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e113 (83.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129 (64.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98 (77.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29 (22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (35.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (84.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55 (75.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18 (24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCategory of empyema thoraces\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.844\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity-acquired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155 (77.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144 (92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e119 (76.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital-acquired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (75.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eetiology of empyema thoraces\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePara-pneumonic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e161 (80.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e154 (95.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e137 (85.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers \u003cem\u003eb\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (35.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (64.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (41.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23 (59.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDelayed treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133 (66.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125 (94.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e116 (87.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (33.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (80.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37 (55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30 (44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInitial pleural drainage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest tube drainage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e200 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e179 ( 89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e153 (66.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVATS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen thoracotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eIQR; Inter-quartile range, b; empyema arising from complications of thoracic trauma, tuberculosis, malignancy, or extension of head/neck infections, VATS; Video Assisted Thoracoscopy.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eOutcomes of empyema thoracis management.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe reintervention rate in this cohort was 23.5% (95% CI: 17.8\u0026ndash;30.0%) (47 patients). Among the patients who required reintervention, 37 (78.7%) underwent a second chest tube insertion, whereas 10 (21.3%) underwent open decortication. The in-hospital mortality rate was 10.5% (95% CI: 6.6% \u0026minus;\u0026thinsp;15.6%) (21 patients). The median length of hospital stay in this cohort was 19 days (IQR\u0026thinsp;=\u0026thinsp;8.3).\u003c/p\u003e\n\u003ch3\u003eFactors associated with in-hospital mortality and reintervention\u003c/h3\u003e\n\u003cp\u003eMultivariate analysis revealed that advanced age and the nonparapneumonic underlying etiology of empyema were significantly associated with an increased risk of in-hospital mortality. The odds of dying from empyema thoracis increased by 4% per year increase in age (adjusted OR: 1.04, 95% CI: 1.01\u0026ndash;1.08). Similarly, the in-hospital mortality of empyema thoraces from underlying causes other than parapneumonic effusion was more than 11 times greater than that of parapneumonic empyema thoracis (adjusted OR\u0026thinsp;=\u0026thinsp;11.45, 95% CI: 2.74\u0026ndash;47.89) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariable and multivaraible analysis of factors associated with in-hospital mortality following empyema thoracis management.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariable analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.03\u0026ndash;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.01\u0026ndash;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.64\u0026ndash;4.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.19\u0026ndash;1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.51\u0026ndash;8.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.319\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.83\u0026ndash;5.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCategory of empyema thoraces\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity-acquired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital-acquired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.47\u0026ndash;9.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.73\u0026ndash;6.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEtiology of empyema thoraces\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePara-pneumonic empyema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers \u003cem\u003eb\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.53\u0026ndash;33.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.74\u0026ndash;47.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDelayed treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.47\u0026ndash;9.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.39\u0026ndash;4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003e*; statistically significant factors at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, OR; Odds ratio, CI; Confidence Interval.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes the univariable and multivariable logistic regression analyses of factors associated with reintervention following initial management of empyema thoraces at our center. The statistically significant factors associated with increased reintervention rates in the multivariate analysis were nonparapneumonic etiology (adjusted OR\u0026thinsp;=\u0026thinsp;3.83, 95% CI: 1.45\u0026ndash;10.10) and a delay of more than 3 days (from diagnosis) to drainage of empyema thoraces (adjusted OR\u0026thinsp;=\u0026thinsp;2.97, 95% CI: 1.33\u0026ndash;6.67).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariable and multivaraible analysis of factors associated with need for re-intervention following initial empyema thoracis management.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariable analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eadjusted OR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.99\u0026ndash;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.98\u0026ndash;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.65\u0026ndash;2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.12\u0026ndash;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.31\u0026ndash;1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.428\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.56\u0026ndash;2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCategory of empyema thoraces\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity-acquired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital-acquired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.49\u0026ndash;2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCause of empyema thoraces\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePara-pneumonic empyema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers \u003cem\u003eb\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.79\u0026ndash;17.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.45\u0026ndash;10.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.007*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDelayed treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.75\u0026ndash;11.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.33\u0026ndash;6.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.008*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003e*; statistically significant factors at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, OR; Odds Ratio, CI; Confidence Interval.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this retrospective cohort study, we evaluated the outcomes and associated factors for empyema thoracis cases managed at a single tertiary hospital in Uganda. Our study provides important insights into the local burden and management outcomes of this often debilitating condition.\u003c/p\u003e\n\u003ch3\u003eIn-hospital mortality of empyema thoracis\u003c/h3\u003e\n\u003cp\u003eWe found an overall in-hospital mortality rate of 10.5% in our cohort, a figure that is still high, albeit within the ranges reported in studies by other authors [14 15]. While the high mortality of empyema thoracis, especially in the developed world, is often attributed to prevalent comorbidities and the aging population [2 4 16], this is not the case in this cohort, which is relatively young and has relatively few comorbidities. The high mortality in our setting may be related to delayed diagnosis and possibly other healthcare system deficiencies.\u003c/p\u003e \u003cp\u003eWe also noted that increasing age was associated with a greater risk of in-hospital mortality in patients with empyema thoracis. Several related studies have also noted this association [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e \u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This finding aligns with the fact that older patients may have diminished physiological reserves, comorbidities, and delayed presentations due to atypical empyema thoracis features, all of which can adversely affect outcomes.\u003c/p\u003e \u003cp\u003ePrevious studies have shown that the number rather than the presence of a single comorbidity is a risk factor for increased mortality in patients with empyema thoracis [1 7 20]. Mitchell and colleagues evaluated the associations between patient comorbidities and clinical outcomes in a large database of hospitalized empyema thoracis cases in the United States (USA). They reported that mortality was not significantly associated with individual comorbidities and that severe cases with 3 or more comorbidities were significantly associated with mortality in patients with empyema thoracis[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Our finding of no significant association between comorbidities and in-hospital mortality agrees with their findings, given that none of our patients had 2 or more comorbidities.\u003c/p\u003e \u003cp\u003eInterestingly, this study revealed that empyema thoracis cases secondary to parapneumonic effusions are associated with a significantly lower in-hospital mortality rate than those arising from other causes, such as tuberculosis, trauma, malignancy and extension of the head and neck or infra-diaphragmatic infections. This may reflect the relatively better prognosis of parapneumonic empyema when diagnosed early and treated aggressively with antibiotics and prompt pleural drainage and the fact that most of the other underlying causes are often associated with poor prognostic factors, such as malnutrition and general debilitation [7 8 15 17].\u003c/p\u003e \u003cp\u003e \u003cem\u003eRe-intervention rate in empyema thoracis treatment.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe rate of reintervention following treatment for patients with empyema thoracis in our study was high (23.5%). Comparable reintervention rates have been noted in other studies [14 20 21]. One key observation in all these studies is that most of the cases evaluated had a late stage of empyema. Although the stage of empyema thoraces was not recorded for most of the patients in our cohort, we noted a significant association of reintervention rates with delays of more than 3 days to drain the empyema, most likely indicating late-stage treatment. An additional reason for the high reintervention rates in our study could be that all our cases were initially managed with chest tube drainage; previous studies have shown high failure rates for this empyema thoracis treatment modality, especially for late-stage empyema [14 20 22].\u003c/p\u003e \u003cp\u003eOur study revealed that patients with empyema thoracis with underlying causes other than parapneumonic effusion had a significantly higher reintervention rate. This finding agrees with several other related series [5 9 23]. Empyema, caused by entities such as malignant effusion and infection extending from the head/neck, can lead to the accumulation of pus in the chest, leading to the need for a longer drainage period and often the need for reintervention. Moreover, these conditions are often associated with malnutrition and overall low immunity; hence, patients are highly likely to have severe or recurrent empyema requiring reintervention.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy limitations.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study has inherent limitations due to its retrospective database design, including possibilities of selection bias and missing or incomplete data, e.g., most of the case files did not have microbiologic culture data, which we believe would have been valuable for examining its impact on the outcomes of empyema thoracis.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThese studies revealed high in-hospital mortality and reintervention rates for empyema thoracis cases managed at our center, with delayed initial intervention, advanced age and nonparapneumonic etiology of empyema being the major factors associated with increased likelihood of reintervention and/or in-hospital mortality. Taken together, our findings underscore the need for early diagnosis and timely intervention in the management of empyema thoracis. Special attention should be given to elderly patients who are at increased risk of mortality, and targeted strategies may be needed for nonparapneumonic causes, which appear to have poorer outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV/AIDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman immunodeficiency virus/acquired immunodeficiency syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eodds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUNCST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUganda National Council of Science and Technology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSOMREC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e School of Medicine Research Ethics Committee of Makerere University\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVATS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVideo-assisted thoracoscopic surgery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eConsent for publication:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthical approval\u003c/em\u003e\u003cem\u003e:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Helsinki declaration of ethical principles of medical research involving human subjects. The approval to conduct the study was granted by ‘School of Medicine Research and Ethics Committee of Makerere University’ (SOMREC) (Ethical approval number: Mak-SOMREC-2022-417).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to participate.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis being a medical- record based retrospective study, obtaining informed consent to participate from each patient was not practically feasible due to missing contact information. We sought \u0026amp; obtained waiver of consent to participate from the Research Ethics Committee of the School of Medicine, Makerere University (SOMREC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eClinical trial number:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData\u0026nbsp;\u003c/em\u003e\u003cem\u003eavailability\u003c/em\u003e\u003cem\u003e:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary data for this study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConflicts of\u0026nbsp;\u003c/em\u003e\u003cem\u003einterest\u003c/em\u003e\u003cem\u003e:\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding Statement:\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any external funding.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthor contribution\u003c/em\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMM was the principal investigator and contributed to conceptualization, drafting of the proposal, data collection, and manuscript draft. RNI performed the statistical analysis, discussed the results, and participated in the drafting of the manuscript. OP contributed to the drafting of the manuscript. JPM and TKM supervised the study. \u0026nbsp;All authors participated in editing and proofreading the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgment.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the contribution of the staffs of the Department of Surgery, Makerere University College of Health Sciences, and Surgical unit of Mulago National Referral Hospital in ensuring a smooth and orderly data collection process.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors’ information.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMM: G\u003c/em\u003eeneral Surgeon, Department of Surgery, International Hospital Kampala (IHK), Uganda. E-mail address; [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOP\u003c/em\u003e: Lecturer, Department of Surgery, Soroti University, Soroti District, Uganda. E-mail; [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRNI\u003c/em\u003e: Associate consultant surgeon, Department of Surgery, Moyo General Hospital, Moyo district, Uganda. E-mail address; [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eJPM:\u003c/em\u003e Lecturer, Department of Surgery, School of medicine, college of health science, Makerere University, Kampala, Uganda. E-mail address: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTKM\u003c/em\u003e: Senior lecturer, Department of Surgery, School of medicine, college of health science, Makerere University, Kampala, Uganda. E-mail address; [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMitchell MA, Deschner E, Dhaliwal I, Amjadi K, Chee A. Association of Patient Demographics and Comorbidities with Clinical Outcomes in Adults Hospitalized for Empyema. Ann Am Thorac Soc 2021;\u003cstrong\u003e18\u003c/strong\u003e(5):904-06 doi: 10.1513/AnnalsATS.202008-1011RL[published Online First: Epub Date]|.\u003c/li\u003e\n \u003cli\u003eCargill TN, Hassan M, Corcoran JP, et al. A systematic review of comorbidities and outcomes of adult patients with pleural infection. European Respiratory Journal 2019;\u003cstrong\u003e54\u003c/strong\u003e(3)\u003c/li\u003e\n \u003cli\u003eAndrew NI, Stephen O, Chukwuemeka EJ, Ndubueze E. Decade Experience in Pleurectomy and Lung Decortications for Chronic Empyema Thoracis. World Journal of Cardiovascular Surgery 2018;\u003cstrong\u003e8\u003c/strong\u003e(10):165-74\u003c/li\u003e\n \u003cli\u003eLehtom\u0026auml;ki AI, Nevalainen RM, Toikkanen VJ, et al. Pleural infection\u0026mdash;an indicator of morbidity and increased burden on health care. Interactive CardioVascular and Thoracic Surgery 2020;\u003cstrong\u003e31\u003c/strong\u003e(4):513-18\u003c/li\u003e\n \u003cli\u003eSundaralingam A, Banka R, Rahman NM. Management of pleural infection. Pulmonary therapy 2021;\u003cstrong\u003e7\u003c/strong\u003e:59-74\u003c/li\u003e\n \u003cli\u003eS\u0026oslash;gaard M, Nielsen RB, N\u0026oslash;rgaard M, Kornum JB, Sch\u0026oslash;nheyder HC, Thomsen RW. Incidence, length of stay, and prognosis of hospitalized patients with pleural empyema: a 15-year Danish nationwide cohort study. Chest 2014;\u003cstrong\u003e145\u003c/strong\u003e(1):189-92\u003c/li\u003e\n \u003cli\u003eNwagboso CI, Ekeng BE, Etiuma AU, Ochang EA, Eze JN, Echieh CP. Microbiological profile and antibiotic resistance pattern of empyema thoracis in Calabar, Nigeria. Trop Doct 2021;\u003cstrong\u003e51\u003c/strong\u003e(4):523-26 doi: 10.1177/00494755211032844[published Online First: Epub Date]|.\u003c/li\u003e\n \u003cli\u003eReichert M, Hecker M, Witte B, et al. Stage-directed therapy of pleural empyema. Langenbeck\u0026apos;s archives of surgery 2017;\u003cstrong\u003e402\u003c/strong\u003e:15-26\u003c/li\u003e\n \u003cli\u003eFeller-Kopman D, Light R. Pleural Disease. N Engl J Med 2018;\u003cstrong\u003e378\u003c/strong\u003e(8):740-51 doi: 10.1056/NEJMra1403503[published Online First: Epub Date]|.\u003c/li\u003e\n \u003cli\u003eRoberts ME, Rahman NM, Maskell NA, et al. British Thoracic Society Guideline for pleural disease. Thorax 2023;\u003cstrong\u003e78\u003c/strong\u003e(Suppl 3):s1-s42 doi: 10.1136/thorax-2022-219784[published Online First: Epub Date]|.\u003c/li\u003e\n \u003cli\u003eBekele A, Alayande BT. Management of Empyema Thoracis in Low-Resource Settings. Thorac Surg Clin 2022;\u003cstrong\u003e32\u003c/strong\u003e(3):361-72 doi: 10.1016/j.thorsurg.2022.02.004[published Online First: Epub Date]|.\u003c/li\u003e\n \u003cli\u003eDje Bi IH, Diabate TP, Yeo L, et al. Therapeutic Path and Outcome of Thoracic Empyema in Bouake: Itin\u0026eacute;raire Th\u0026eacute;rapeutique et \u0026Eacute;volution des Empy\u0026egrave;mes Thoraciques \u0026agrave; Bouake. HEALTH RESEARCH IN AFRICA 2024;\u003cstrong\u003e2\u003c/strong\u003e(9) doi: 10.5281/hra.v2i9.6012[published Online First: Epub Date]|.\u003c/li\u003e\n \u003cli\u003eSullivan M, Soe M. Sample size for cross-sectional, cohort, or clinical trial studies, 2019.\u003c/li\u003e\n \u003cli\u003eSemenkovich TR, Olsen MA, Puri V, Meyers BF, Kozower BD. Current State of Empyema Management. The Annals of Thoracic Surgery 2018;\u003cstrong\u003e105\u003c/strong\u003e(6):1589-96 doi: https://doi.org/10.1016/j.athoracsur.2018.02.027[published Online First: Epub Date]|.\u003c/li\u003e\n \u003cli\u003eAtif M, Naseem M, Sarwar S, et al. Spectrum of microorganisms, antibiotic resistance pattern, and treatment outcomes among patients with empyema thoracis: A descriptive cross-sectional study from the Bahawal Victoria Hospital Bahawalpur, Punjab, Pakistan. Frontiers in Medicine 2021;\u003cstrong\u003e8\u003c/strong\u003e:665963\u003c/li\u003e\n \u003cli\u003eMarks DJ, Fisk MD, Koo CY, et al. Thoracic empyema: a 12-year study from a UK tertiary cardiothoracic referral center. PloS one 2012;\u003cstrong\u003e7\u003c/strong\u003e(1):e30074\u003c/li\u003e\n \u003cli\u003eRedden MD, Chin TY, van Driel ML. Surgical versus non‐surgical management for pleural empyema. Cochrane Database of Systematic Reviews 2017(3) doi: 10.1002/14651858.CD010651.pub2[published Online First: Epub Date]|.\u003c/li\u003e\n \u003cli\u003eRahman NM, Kahan BC, Miller RF, Gleeson FV, Nunn AJ, Maskell NA. A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. Chest 2014;\u003cstrong\u003e145\u003c/strong\u003e(4):848-55\u003c/li\u003e\n \u003cli\u003eSmith JA, Mullerworth MH, Westlake GW, Tatoulis J. Empyema thoracis: 14-year experience in a teaching center. Ann Thorac Surg 1991;\u003cstrong\u003e51\u003c/strong\u003e(1):39-42 doi: 10.1016/0003-4975(91)90443-t[published Online First: Epub Date]|.\u003c/li\u003e\n \u003cli\u003eHuang H-C, Chang H-Y, Chen C-W, Lee C-H, Hsiue T-R. Predicting factors for outcome of tube thoracostomy in complicated parapneumonic effusion or empyema. Chest 1999;\u003cstrong\u003e115\u003c/strong\u003e(3):751-56\u003c/li\u003e\n \u003cli\u003eKuo S‒W, Tseng Y-F, Dai K-Y, Chang Y-C, Chen K-C, Lee J-M. Electromagnetic navigation bronchoscopy localization versus percutaneous CT-guided localization for lung resection via video-assisted thoracoscopic surgery: a propensity-matched study. Journal of Clinical Medicine 2019;\u003cstrong\u003e8\u003c/strong\u003e(3):379\u003c/li\u003e\n \u003cli\u003eWozniak CJ, Paull DE, Moezzi JE, et al. Choice of first intervention is related to outcomes in the management of empyema. The Annals of thoracic surgery 2009;\u003cstrong\u003e87\u003c/strong\u003e(5):1525-31\u003c/li\u003e\n \u003cli\u003eShen KR, Bribriesco A, Crabtree T, et al. The American Association for Thoracic Surgery consensus guidelines for the management of empyema. The Journal of thoracic and cardiovascular surgery 2017;\u003cstrong\u003e153\u003c/strong\u003e(6):e129-e46\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Empyema thoracis, outcomes, in-hospital mortality, and reintervention.","lastPublishedDoi":"10.21203/rs.3.rs-6579182/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6579182/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003eEmpyema thoracis is a debilitating illness observed in all age groups. Recent data indicate increasing incidence rates and worsening outcomes. However, published data on the outcomes of empyema thoracis cases in our setting are scarce.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study evaluated outcomes and associated factors for adult empyema thoracis patientsmanaged at a single tertiary center in Uganda.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: We reviewed the file records of patients 18 years or older who were managed for empyema thoracis at Mulago National Referral Hospital from January 2017 to December 2021. Sociodemographic data, comorbidities, clinical parameters at admission, and management strategies were reviewed. The outcomes of interest were in-hospital mortality and the need for reintervention. A multivariate logistic regression model was used to identify independent factors associated with the need for reintervention and in-hospital mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 200 case files were analyzed, and 123 (61.5%) of the cases were males. The median age of the cohort was 33 years (IQR=21). The in-hospital mortality rate was 10.5% (21 patients), and 23.5% (47 patients) required one or more reinterventions. Advancing age (adjusted OR=1.04 (1.01–1.08)) and nonparapneumonicunderlying etiology (adjusted OR=11.45 (2.74–47.89)) were independently associated with increased in-hospital mortality, whereas delayed empyema drainage (adjusted OR=2.97 (1.33–6.67)) and underlying nonparapneumonic etiology (adjusted OR=3.83 (1.45–10.10.10)) significantly increased the odds of the need for reintervention in management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The in-hospital mortality and reintervention rates for empyema thoracis were high in our study. Particularly at-risk groups for these poor outcomes are those with advanced age, nonparapneumonic empyema thoraces, and delayed initial intervention.\u003c/p\u003e","manuscriptTitle":"Outcomes of Adult Empyema Thoracis Cases Managed in a Tertiary Hospital in Uganda: a Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-14 08:54:10","doi":"10.21203/rs.3.rs-6579182/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-16T11:31:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-15T11:37:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106991468819269154722146628425163664030","date":"2025-06-15T10:12:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-06T12:57:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159677655898071898038988891367334342232","date":"2025-06-02T13:51:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206788046809434233541837131130859532500","date":"2025-05-14T19:18:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19828714768382210067743571878023348802","date":"2025-05-09T07:03:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-09T06:50:49+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-08T06:04:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-08T03:40:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-08T03:37:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-05-02T14:26:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"20be52bf-c3f9-411d-884f-93ed51da0ef0","owner":[],"postedDate":"May 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-04T16:49:28+00:00","versionOfRecord":{"articleIdentity":"rs-6579182","link":"https://doi.org/10.1186/s12890-025-03861-0","journal":{"identity":"bmc-pulmonary-medicine","isVorOnly":false,"title":"BMC Pulmonary Medicine"},"publishedOn":"2025-08-01 16:38:04","publishedOnDateReadable":"August 1st, 2025"},"versionCreatedAt":"2025-05-14 08:54:10","video":"","vorDoi":"10.1186/s12890-025-03861-0","vorDoiUrl":"https://doi.org/10.1186/s12890-025-03861-0","workflowStages":[]},"version":"v1","identity":"rs-6579182","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6579182","identity":"rs-6579182","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}