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Sonographic septation: a useful diagnostic predictor of complicated parapneumonic effusion

Shan-Yueh Chang, Ying-Chieh Chen, Chen-Liang Tsai, Shih-Wei Wu, Chung-Kan Peng, Chih-Hao Shen, Yu-Ching Chou, Chih-Feng Chian
DOI: 10.1136/jim-2020-001770 Published 19 July 2021
Shan-Yueh Chang
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
2Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
3Hyperbaric Oxygen Center, Division of Pulmonary Medicine and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Ying-Chieh Chen
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Chen-Liang Tsai
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Shih-Wei Wu
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
2Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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Chung-Kan Peng
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
3Hyperbaric Oxygen Center, Division of Pulmonary Medicine and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Chih-Hao Shen
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
3Hyperbaric Oxygen Center, Division of Pulmonary Medicine and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Yu-Ching Chou
4School of Public Health, National Defense Medical Center, Taipei, Taiwan
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Chih-Feng Chian
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Abstract

Sonographic septation is associated with prolonged hospitalization and increased mortality in patients diagnosed with empyema. However, it is unknown whether sonographic septation is associated with complicated parapneumonic effusion (CPPE) or the need for invasive procedures among patients with pneumonia. In this retrospective study, we included 180 patients with non-purulent neutrophilic exudative pleural effusion secondary to pulmonary infections such as pneumonia and lung abscess. We performed univariate and multivariate logistic regression analyses, including baseline clinical characteristics, values from blood samples, and sonographic echogenicity, to identify variables correlated with CPPE and the need for invasive procedures. Seventy of the 180 included patients (38.89%) displayed sonographic septation. Multivariate logistic regression analysis identified that sonographic septation (adjusted OR (AOR)=3.38 (95% CI 1.64 to 6.98), p=0.001) and younger age (AOR=2.63 (95% CI 1.24 to 5.58), p=0.012) were independently associated with CPPE. With regard to treatment strategy, sonographic septation (AOR 9.06 (95% CI 3.71 to 22.11), p<0.001) and total serum protein level (AOR=1.80 (95% CI 1.13 to 2.86), p=0.013) were independently associated with the need for subsequent invasive procedures in patients with CPPE using multivariate logistic regression analysis. Sonographic septation is a useful predictor of CPPE and may imply the need for early invasive procedures.

Footnotes

  • Contributors S-YC wrote the first draft of this article. All authors contributed to acquisition, analysis, and interpretation of data. The principal author takes full responsibility for the data presented in this study, analysis of data, conclusions, and conduct of the research.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Vol 70 Issue 8 Table of Contents
Journal of Investigative Medicine: 70 (8)
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Sonographic septation: a useful diagnostic predictor of complicated parapneumonic effusion
Shan-Yueh Chang, Ying-Chieh Chen, Chen-Liang Tsai, Shih-Wei Wu, Chung-Kan Peng, Chih-Hao Shen, Yu-Ching Chou, Chih-Feng Chian
Journal of Investigative Medicine Jul 2021, jim-2020-001770; DOI: 10.1136/jim-2020-001770

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Sonographic septation: a useful diagnostic predictor of complicated parapneumonic effusion
Shan-Yueh Chang, Ying-Chieh Chen, Chen-Liang Tsai, Shih-Wei Wu, Chung-Kan Peng, Chih-Hao Shen, Yu-Ching Chou, Chih-Feng Chian
Journal of Investigative Medicine Jul 2021, jim-2020-001770; DOI: 10.1136/jim-2020-001770
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Sonographic septation: a useful diagnostic predictor of complicated parapneumonic effusion
Shan-Yueh Chang, Ying-Chieh Chen, Chen-Liang Tsai, Shih-Wei Wu, Chung-Kan Peng, Chih-Hao Shen, Yu-Ching Chou, Chih-Feng Chian
Journal of Investigative Medicine Jul 2021, jim-2020-001770; DOI: 10.1136/jim-2020-001770
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