Predictors of prolonged stay in patients with community-acquired pneumonia and complicated parapneumonic effusion.
OBJECTIVE
Development of CPE in CAP is associated with prolonged hospital stay and it may increase the morbidity and mortality. We aimed to identify microbiological and clinical factors that predicate a prolonged hospital admission in patients treated with a tube thoracostomy to control CPE.


METHODS
This retrospective cohort included patients with CPE requiring chest tube drainage in a tertiary referral Korean hospital from 1 January 2004 to 30 July 2012. After dichotomous grouping according to the mean duration of hospital stay, clinical, laboratory and microbiological parameters were compared.


RESULTS
The final analysis included 158 patients with CPE. The majority were male (130, 85.0%), and the mean age was 62.8 years. The mean duration of hospital stay was 17.7 (±10.2) days. The mean duration of chest tube drainage was 9.6 (±6.7) days. Streptococcus viridans (48.4%) was the most common pathogen. Intrapleural fibrinolysis was performed in 85 (53.8%); additional tube insertion was needed in 40 (25.3%) patients. In the multivariate analysis after adjusting for covariates, a prolonged hospital stay was associated with fever (aOR: 3.42, P = 0.02), lower PaO2 (aOR: 4.89, P = 0.007) and haemoglobin (aOR: 4.90, P = 0.003) levels, and an increased blood neutrophil fraction (aOR: 3.83, P = 0.01) on admission as well as the identification of microbes in CPE (aOR: 4.14, P = 0.03), and ineffective pleural drainage (aOR: 3.28, P = 0.03).


CONCLUSIONS
This study suggests that physicians should note the clinical symptoms and laboratory findings of severe infection and effectiveness of pleural drainage to predicate which patients with a CAP needing thoracostomy for CPE will have a prolonged hospital stay.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Junghyun
J
Kim
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
Jong Sun
JS
Park
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
Young-Jae
YJ
Cho
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
Ho Il
HI
Yoon
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
Jae Ho
JH
Lee
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
Choon-Taek
CT
Lee
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
Hyo-Jeong
HJ
Lim
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
Deog Kyeom
DK
Kim
D000328:Adult; D000368:Aged; D015505:Chest Tubes; D017714:Community-Acquired Infections / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology / Q000382:microbiology / Q000601:surgery; D011014:Pneumonia / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D011379:Prognosis; D056910:Republic of Korea; D012189:Retrospective Studies; D013907:Thoracostomy / Q000009:adverse effects / Q000379:methods; D034363:Viridans Streptococci / Q000302:isolation & purification*
hospital stay; microbial result; parapneumonic effusion; pleural effusion