title: Outcome predictors of cirrhotic patients with spontaneous bacterial empyema.
abstract: BACKGROUND
  Spontaneous bacterial empyema (SBE) is a complication of cirrhotic patients in which a pre-existing pleural effusion becomes infected. This retrospective study was designed to investigate the bacteriology and outcome predictors of SBE in cirrhotic patients.
  
  
  METHODS
  Medical records of cirrhotic patients treated in a tertiary care university hospital from December 2004 to December 2008 were retrospectively reviewed.
  
  
  RESULTS
  Of 3390 cirrhotic patients seen during the study period, 81 cases of SBE were diagnosed. The incidence of SBE was 2.4% (81/3390) in cirrhotic patients and 16% (81/508) in patients with cirrhosis with hydrothorax. There were 46 monomicrobial infections found in 46 SBE patients. Aerobic Gram-negative organisms were the predominant pathogens (n=29, 63%), and Escherichia coli (n=9, 20%) was the most frequently isolated sole pathogen. The mortality rate of SBE was 38% (31/81). Univariate analysis showed that Child-Pugh score, model for end-stage liver disease (MELD)-Na score, concomitant bacteraemia, concomitant spontaneous bacterial peritonitis, initial intensive care unit (ICU) admission and initial antibiotic treatment failure were predictors of poor outcomes. Multivariate regression analysis demonstrated that the independent factors related to a poor outcome were initial ICU admission [odds ratio (OR): 4.318; 95% confidence interval 1CI) 1.09-17.03; P=0.037], MELD-Na score (OR: 1.267; 95% CI 1.08-1.49; P=0.004) and initial antibiotic treatment failure (OR: 13.10; 95% CI 2.60-66.03).
  
  
  CONCLUSIONS
  Spontaneous bacterial empyema in cirrhotic patients is a high mortality complication. The independent factors related to poor outcome are high MELD-Na score, initial ICU admission and initial antibiotic treatment failure. High MELD-Na score may be a useful mortality predictor of SBE in cirrhotic patients.
authors.affiliation: Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Chuen-Ming
authors.initials: CM
authors.lastname: Shih
authors.forename: Jen-Wei
authors.initials: JW
authors.lastname: Chou
authors.forename: Yi-Heng
authors.initials: YH
authors.lastname: Liu
authors.forename: Liang-Wen
authors.initials: LW
authors.lastname: Hang
authors.forename: Te-Chun
authors.initials: TC
authors.lastname: Hsia
authors.forename: Wu-Huei
authors.initials: WH
authors.lastname: Hsu
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Tu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D016724:Empyema, Pleural / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006876:Hydrothorax / Q000453:epidemiology / Q000473:pathology; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents