Abstract：
OBJECTIVE: Although intrapleural administration of fibrinolytics is an important treatment option for the management of empyema, the addition of fibrinolytics failed to reduce the need for surgery and mortality in previous randomized controlled trials. This study aimed to investigate the effects of administrating fibrinolytics in the early phase (within 3 days of chest tube insertion) of empyema compared with late administration or no administration.
METHODS: We used the Japanese Diagnosis Procedure Combination Inpatient Database to identify patients aged ≥16 years who were hospitalized and underwent chest tube drainage for empyema. A 1:2 propensity score matching and stabilized inverse probability of treatment weighting were conducted.
RESULTS: Among the 16 265 eligible patients, 3082 and 13 183 patients were categorized into the early and control group, respectively. The proportion of patients who underwent surgery was significantly lower in the early fibrinolytics group than in the control group; the odds ratio (95% confidence interval) was 0.69 (0.54-0.88) in the propensity score matching (P = 0.003) and 0.64 (0.50-0.80) in the stabilized inverse probability of treatment weighting analysis (P < 0.001). All-cause 30-day in-hospital mortality, length of hospital stay, duration of chest tube drainage, and total hospitalization costs were also more favourable in the early fibrinolytics group.
CONCLUSIONS: The early administration of fibrinolytics may reduce the need for surgery and death in adult patients with empyema.
METHODS: We used the Japanese Diagnosis Procedure Combination Inpatient Database to identify patients aged ≥16 years who were hospitalized and underwent chest tube drainage for empyema. A 1:2 propensity score matching and stabilized inverse probability of treatment weighting were conducted.
RESULTS: Among the 16 265 eligible patients, 3082 and 13 183 patients were categorized into the early and control group, respectively. The proportion of patients who underwent surgery was significantly lower in the early fibrinolytics group than in the control group; the odds ratio (95% confidence interval) was 0.69 (0.54-0.88) in the propensity score matching (P = 0.003) and 0.64 (0.50-0.80) in the stabilized inverse probability of treatment weighting analysis (P < 0.001). All-cause 30-day in-hospital mortality, length of hospital stay, duration of chest tube drainage, and total hospitalization costs were also more favourable in the early fibrinolytics group.
CONCLUSIONS: The early administration of fibrinolytics may reduce the need for surgery and death in adult patients with empyema.
摘要：
目的：尽管胸膜腔内给予纤溶药物是治疗脓胸的重要选择，在以往的随机对照试验中,添加纤维蛋白溶解剂未能降低手术需求和死亡率.这项研究旨在研究与晚期给药或不给药相比，在脓胸的早期（胸管插入后3天内）给药纤维蛋白溶解剂的作用。
方法：我们使用日本诊断程序联合住院数据库来识别年龄≥16岁的患者，这些患者因脓胸住院并接受了胸腔引流。进行1:2倾向评分匹配和稳定的治疗加权逆概率。
结果：在16,265名符合条件的患者中，3,082例和13,183例患者分为早期组和对照组，分别。早期纤维蛋白溶解组接受手术的患者比例明显低于对照组；倾向评分匹配的比值比（95％置信区间）为0.69（0.54-0.88）（P=0.003），治疗加权分析的稳定逆概率为0.64（0.50-0.80）（P<0.001）。全因30天住院死亡率，住院时间,胸管引流的持续时间，早期纤溶治疗组的总住院费用也更有利。
结论：早期使用纤维蛋白溶解剂可以减少成年脓胸患者的手术需求和死亡。
方法：我们使用日本诊断程序联合住院数据库来识别年龄≥16岁的患者，这些患者因脓胸住院并接受了胸腔引流。进行1:2倾向评分匹配和稳定的治疗加权逆概率。
结果：在16,265名符合条件的患者中，3,082例和13,183例患者分为早期组和对照组，分别。早期纤维蛋白溶解组接受手术的患者比例明显低于对照组；倾向评分匹配的比值比（95％置信区间）为0.69（0.54-0.88）（P=0.003），治疗加权分析的稳定逆概率为0.64（0.50-0.80）（P<0.001）。全因30天住院死亡率，住院时间,胸管引流的持续时间，早期纤溶治疗组的总住院费用也更有利。
结论：早期使用纤维蛋白溶解剂可以减少成年脓胸患者的手术需求和死亡。
