Abstract：
Rationale: Chest computed tomography is performed in patients with empyema for various reasons. However, its predictive ability for patient outcomes in empyema has not been evaluated. Objectives: To evaluate the predictive ability of computed tomography findings (pleural thickness, loculation, interlobar pleural effusion, lung abscess, and bronchopleural fistula) for 90-day mortality in empyema. Methods: This multicenter retrospective cohort study was conducted across six acute care hospitals in Japan. We included patients with confirmed empyema diagnoses who underwent chest computed tomography within 7 days of diagnosis. Imaging findings were defined as pleural thickness, loculation, interlobar pleural effusion, lung abscess, or bronchopleural fistula. One radiologist interpreted the computed tomography scans without patient information. The primary outcome was 90-day mortality. We calculated the differences in 90-day mortality between the presence and absence of each computed tomography finding using logistic regression with or without adjustment for early thoracic surgery. Results: A total of 711 patients were included in our study. Thoracic surgery was performed in 27% of patients, and the 90-day mortality rate was 10%. The differences (95% confidence intervals) in 90-day mortality without and with adjustment for early thoracic surgery were as follows: pleural thickness, 3.09% (-1.35% to 7.54%) and 2.70% (-1.80% to 7.20%); loculation, -4.01% (-8.61% to 0.60%) and -3.80% (-8.41% to 0.81%); interlobar pleural effusion, -9.15% (-14.58% to -3.72%) and -8.96% (-14.39% to -3.53%); lung abscess, 7.04% (-1.16% to 15.2%) and 6.86% (-1.34% to 15.05%); and bronchopleural fistula, 13.80% (7.66% to 19.94%) and 13.63% (7.50% to 19.77%), respectively. Conclusions: Although interlobar pleural effusion predicted lower 90-day mortality regardless of early thoracic surgery, the presence of bronchopleural fistula predicted higher 90-day mortality with empyema. Our results warrant further validation.
摘要：
背景：由于各种原因对脓胸患者进行胸部计算机断层扫描。然而,其对脓胸患者预后的预测能力尚未评估.
目的：评估计算机断层扫描结果的预测能力（胸膜厚度，定位,叶间胸腔积液，肺脓肿,和支气管胸膜瘘）用于脓胸的90天死亡率。
方法：这项多中心回顾性队列研究是在日本六家急性护理医院进行的。我们纳入了确诊脓胸的患者，这些患者在诊断后7天内接受了胸部计算机断层扫描。影像学检查结果定义为胸膜厚度，定位,叶间胸腔积液，肺脓肿,或者支气管胸膜瘘.一位放射科医师在没有患者信息的情况下解释了计算机断层扫描。主要结果是90天死亡率。我们使用逻辑回归进行了或不进行早期胸外科手术的调整，计算了每个计算机断层扫描发现的存在和不存在之间的90天死亡率差异。
结果：本研究共纳入711例患者。27％的患者进行了胸外科手术，90天死亡率为10％。不进行或控制早期胸外科手术的90天死亡率差异如下：胸膜厚度，3.09%（95%置信区间：-1.35-7.54%），2.70%（-1.80%至7.20%）；定位，-4.01%（-8.61%至0.60%），-3.80%（-8.41-0.81%）；叶间胸腔积液，-9.15%（-14.58%至-3.72%），-8.96%（-14.39%至-3.53%）；肺脓肿，7.04%（-1.16-15.2%），6.86%（-1.34-15.05%）；支气管胸膜瘘，13.80%（7.66-19.94%），13.63%（7.50-19.77%），分别。
结论：虽然叶间胸腔积液可预测90天死亡率较低，而与早期胸外科手术无关，支气管胸膜瘘的存在预示脓胸患者90天死亡率较高.我们的结果值得进一步验证。
目的：评估计算机断层扫描结果的预测能力（胸膜厚度，定位,叶间胸腔积液，肺脓肿,和支气管胸膜瘘）用于脓胸的90天死亡率。
方法：这项多中心回顾性队列研究是在日本六家急性护理医院进行的。我们纳入了确诊脓胸的患者，这些患者在诊断后7天内接受了胸部计算机断层扫描。影像学检查结果定义为胸膜厚度，定位,叶间胸腔积液，肺脓肿,或者支气管胸膜瘘.一位放射科医师在没有患者信息的情况下解释了计算机断层扫描。主要结果是90天死亡率。我们使用逻辑回归进行了或不进行早期胸外科手术的调整，计算了每个计算机断层扫描发现的存在和不存在之间的90天死亡率差异。
结果：本研究共纳入711例患者。27％的患者进行了胸外科手术，90天死亡率为10％。不进行或控制早期胸外科手术的90天死亡率差异如下：胸膜厚度，3.09%（95%置信区间：-1.35-7.54%），2.70%（-1.80%至7.20%）；定位，-4.01%（-8.61%至0.60%），-3.80%（-8.41-0.81%）；叶间胸腔积液，-9.15%（-14.58%至-3.72%），-8.96%（-14.39%至-3.53%）；肺脓肿，7.04%（-1.16-15.2%），6.86%（-1.34-15.05%）；支气管胸膜瘘，13.80%（7.66-19.94%），13.63%（7.50-19.77%），分别。
结论：虽然叶间胸腔积液可预测90天死亡率较低，而与早期胸外科手术无关，支气管胸膜瘘的存在预示脓胸患者90天死亡率较高.我们的结果值得进一步验证。
