title: Thoracic empyema in patients with liver cirrhosis: clinical characteristics and outcome analysis of thoracoscopic management.
abstract: OBJECTIVE
  Thoracic empyema in cirrhotic patients is a challenging situation, and the clinical characteristics are rarely reported. The objective of this study was to report the clinical characteristics among this group and to evaluate whether thoracoscopic intervention would affect clinical outcomes.
  
  
  METHODS
  Between 2001 and 2010, we retrospectively reviewed the clinical characteristics, bacteriologic studies, and treatment outcomes of 63 cirrhotic patients with thoracic empyema. A propensity-score based process, matched on age, sex, diabetes mellitus, malignancy, cause, and Child-Pugh classification (A, B, or C), was performed to equalize potential prognostic factors in thoracoscopy and nonthoracoscopy groups. The Kaplan-Meier curve and log-rank test were applied to compare the survival to discharge between the 2 matched groups.
  
  
  RESULTS
  The median patient age was 61 years. Thirty-two patients (51%) underwent thoracoscopic management, and the remaining patients underwent thoracocentesis or tube thoracostomy. The median hospital stay was 28 days, and 19 patients (30%) had in-hospital mortality. Multivariate analysis showed that Child-Pugh C disease and positive blood cultures were risk factors for in-hospital mortality (P = .016 and .027, respectively), whereas thoracoscopic management may be favorable for survival (P = .041). The propensity score-matched analysis showed a significant reduction in intensive care unit stay (P = .044) in the thoracoscopy group. Kaplan-Meier survival analysis revealed a higher survival to discharge, favoring thoracoscopy over non-thoracoscopy treatment (P = .035).
  
  
  CONCLUSIONS
  Management of thoracic empyema in cirrhotic patients is complicated and associated with a high mortality. With proper patient selection, thoracoscopic management is feasible and may provide a better chance of survival.
authors.affiliation: Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan.
authors.forename: Ke-Cheng
authors.initials: KC
authors.lastname: Chen
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Tseng
authors.forename: Shuenn-Wen
authors.initials: SW
authors.lastname: Kuo
authors.forename: Pei-Ming
authors.initials: PM
authors.lastname: Huang
authors.forename: Hsao-Hsun
authors.initials: HH
authors.lastname: Hsu
authors.forename: Jang-Ming
authors.initials: JM
authors.lastname: Lee
authors.forename: Jin-Shing
authors.initials: JS
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003422:Critical Care; D016724:Empyema, Pleural / Q000209:etiology / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019152:Paracentesis; D010351:Patient Discharge; D018579:Patient Selection; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013907:Thoracostomy; D013997:Time Factors; D016896:Treatment Outcome