Role of Thoracic Ultrasound in Predicting Prognosis in Patients With Parapneumonic Effusions

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BACKGROUND: The presence of pleural effusion in pneumonia is associated with a high risk of thoracic surgery and death. Current prediction scores do not incorporate sonographic findings. There are no studies to date examining the prognostic significance of thoracic ultrasound (TUS) in the current era of intrapleural enzyme treatment for parapneumonic effusions. METHODS: This was a retrospective analysis of prospectively collected data of hospitalized adult patients with parapneumonic effusions. Patient demographics, pleural fluid analysis (PFA), and TUS data were obtained. The primary objective is to determine whether TUS can predict unfavorable outcomes of in-hospital death or thoracic surgery in patients with parapneumonic effusions. RESULTS: A total of 186 parapneumonic effusions were identified. The majority of effusions were echogenic (124/186, 67%), and most had septations (105/124, 85%). An unfavorable outcome occurred in 35% (65/186), including 14% (26/186) who had in-hospital death and 21% (39/186) who had thoracic surgery. The presence of echogenicity (HR: 2.03, 95% CI: 1.10-3.73, P=0.02) and empyema (HR: 2.41, 95% CI: 1.46-3.97, P<0.01) was associated with the unfavorable outcomes. However, sonographic findings were not independent predictors of in-hospital death or thoracic surgery in multivariate analysis. CONCLUSION: Sonographic evidence of echogenic effusion was associated with higher in-hospital death and thoracic surgery. Nevertheless, TUS findings were not independent predictors of in-hospital death or thoracic surgery in patients with parapneumonic effusions.

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