Evaluation of Predictive Factors of Empyema in Children with Parapneumonic Pleural Effusion

Background :

Empyema is a complication of bacterial pneumonia which has a particular importance due to its significant morbidity and mortality in children. The aim of this study was to investigate the prognostic factors of empyema in children with parapneumonic pleural effusion.

This retrospective cross-sectional study investigated all patients under 14 years old with parapneumonic pleural effusion associated with community-acquired pneumonia (CAP) who were hospitalized in Tabriz Children's Hospital, Tabriz, Iran, between March 2016 and March 2020 (4 years). Demographic and clinical characteristics were collected via medical records of patients and assessed as possible factors for empyema. These included: pre-treatments with ibuprofen, antibiotic therapy before admission, duration of the disease, underling diseases, fever, tachycardia, tachypnea, and also some paraclinical variables such as leukocytosis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), acidosis, blood, and pleural fluid culture results.

Empyema associated with parapneumonic pleural effusion was detected in 47 patients (41.2%) of 114 hospitalized children. Based on logistic regression modeling, ibuprofen consumption history (OR = 7.16; 95% CI: 1.35-37.80; p = 0.02), tachypnea (OR = 17.13; 95% CI: 1.63- 179.90; p = 0.01), and leukocytosis (OR= 5.66; 95% CI: 2.10-15.24; p = 0.003) had a significant relationship with empyema occurrence. 

Conclusion:

 Based on the findings of this study, the history of ibuprofen use, tachypnea, and leukocytosis were predictive factors for empyema in children with parapneumonic pleural effusion as a result of community-acquired pneumonia.