Logistic regression analysis of clinical and computed tomography features of pulmonary abscesses and risk factors for pulmonary abscess-related empyema

Cai, Xing-Dong; Yang, Ying; Li, Jinzhong; Liao, Xiaoying; Qiu, Shijie; Xu, Jingjing; Zhang, Miao; Huang, Yuanshun; Huang, Zhi-Hong; Ma, Hong-Ming

doi:10.6061/clinics/2019/e700

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ORIGINAL ARTICLE • Clinics 74 • 2019 • https://doi.org/10.6061/clinics/2019/e700 copy

Logistic regression analysis of clinical and computed tomography features of pulmonary abscesses and risk factors for pulmonary abscess-related empyema

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES:

This study was conducted to investigate the risk factors for pulmonary abscess-related empyema by investigating the clinical characteristics and chest computed tomography imaging features of patients with pulmonary abscesses.

METHODS:

We retrospectively analyzed the chest computed tomography findings and clinical features of 101 cases of pulmonary abscess, including 25 cases with empyema (the experimental group) and 76 cases with no empyema (the control group). The potential risk factors for pulmonary abscess-related empyema were compared between the groups by using univariate and multivariate logistic regression analyses.

RESULTS:

The incidence of pulmonary abscess-related empyema was 24.8% (25/101). Univariate analysis showed that male gender, diabetes, pleuritic symptoms, white blood cells >10×10⁹/L, albumin level <25 g/L, and positive sputum cultures were potential clinical-related risk factors and that an abscess >5 cm in diameter and transpulmonary fissure abscesses were potential computed tomography imaging-related risk factors for pulmonary abscess-related empyema. Multivariate logistic regression analysis showed that transpulmonary fissure abscesses (odds ratio=9.102, p=0.003), diabetes (odds ratio=9.066, p=0.003), an abscess >5 cm in diameter (odds ratio=8.998, p=0.002), and pleuritic symptoms (odds ratio=5.395, p=0.015) were independent risk factors for pulmonary abscess-related empyema.

CONCLUSIONS:

Transpulmonary fissure abscesses, diabetes, giant pulmonary abscesses, and pleuritic symptoms increased the risk of empyema among patients with pulmonary abscesses.

Pulmonary Abscess; Pulmonary Abscess-Related Empyema; Risk Factors

Clinical characteristics	n (%)
Age (years)
≤65	80 (79.2)
>65	21 (20.8)
Gender
Male	68 (67.3)
Female	33 (32.7)
Smoking
Yes	32 (31.7)
No	69 (68.3)
Diabetes mellitus
Yes	33 (32.7)
No	68 (67.3)
Malignant tumor
Yes	13 (12.9)
No	88 (87.1)
Inflammatory bronchial disease
Yes	16 (15.8)
No	85 (84.2)
Renal insufficiency
Yes	11 (10.9)
No	90 (89.1)
Time from onset to admission
≤1 week	40 (39.6)
1∼2 weeks	24 (23.8)
>2 weeks	37 (36.6)
Fever
Yes	47 (46.5)
No	54 (53.5)
Occurrence of pleuritic symptoms
Yes	47 (46.5)
No	54 (53.5)
Hemoptysis or bloody sputum
Yes	12 (11.9)
No	89 (88.1)
White blood cell count (×10⁹/L)
≤10	44 (43.6)
>10	57 (56.4)
Hemoglobin (g/dl)
<11	35 (34.7)
≥11	66 (65.3)
Glycated hemoglobin (%)
≤6.1	4/33 (12.1)
>6.1	29/33 (87.9)
Albumin level (g/dl)
<2.5	18 (17.8)
2.5∼3.5	49 (48.5)
>3.5	34 (33.7)
Pathogenic bacteria in sputum
Positive	19 (18.8)
Negative	71 (70.3)
No sputum	11 (10.9)
Etiology of the pulmonary abscess
Primary	74 (73.3)
Secondary	27 (26.7)
Clinical outcome
Death	3 (2.97)
Not improved	5 (4.9)
Improved or cured	93 (92.08)

Chest CT imaging features	n (%)
Pulmonary abscess location
Right upper lobe	14 (13.9)
Right middle lobe	2 (1.98)
Right lower lobe	23 (22.77)
Left upper lobe	12 (11.88)
Left lower lobe	15 (14.85)
Bilateral pulmonary multiple lesions	16 (15.84)
Unilateral pulmonary multiple lesions	19 (18.81)
Maximum diameter of the pulmonary abscess
≥5 cm	42 (41.6)
<5 cm	59 (58.4)
Multiple pulmonary abscesses
Yes	35 (34.7)
No	66 (65.3)
Multilocular pulmonary abscess
Yes	34 (33.7)
No	67 (66.3)
Cavity formation of pulmonary abscess
Yes	60 (59.4)
No	41 (40.6)
Pulmonary abscess-related empyema
Yes	25 (24.8)
No	76 (75.2)
Transpulmonary fissure abscess
Yes	18 (17.8)
No	83 (82.2)
Wall thickness of the pulmonary abscess
>5 mm	46 (45.5)
≤5 mm	55 (54.5)
Clear edge of the pulmonary abscess
Yes	30 (29.7)
No	71 (70.3)

Variables	n	Empyema	χ²	p
Age (years)
≤65	80	18	1.05	0.31
>65	21	7
Gender
Male	68	21	4.199	0.04
Female	33	4
Smoking
Yes	32	8	0.002	0.97
No	69	17
Diabetes mellitus
Yes	33	14	8.218	0.004
No	68	11
Malignant tumor
Yes	13	2	0.703	0.402
No	88	23
Inflammatory bronchial diseases
Yes	16	2	0.85	0.356
No	85	23
Renal insufficiency
Yes	11	2	0.286	0.593
No	90	23
Time from onset to admission
<1 week	40	11	4.76	0.092
1∼2 weeks	24	9
>2 weeks	37	5
Fever
Yes	47	15	2.42	0.12
No	54	10
Pleuritic symptoms
Yes	47	18	8.66	0.003
No	54	7
Hemoptysis or bloody sputum
Yes	12	1	1.971	0.16
No	89	24
White blood cell count (×10⁹/L)
≤10	44	5	11.095	0.001
>10	57	20
Hemoglobin (g/dl)
<11	35	8	0.103	0.748
≥11	66	17
Albumin level (g/dl)
<2.5	18	9	6.989	0.012
≥2.5	47	16
Pathogenic bacteria in sputum
Positive	19	9	7.305	0.026
Negative	71	15
No sputum	11	1
Etiology of the lung abscess
Primary	74	20	0.769	0.381
Secondary	27	5

Variables	n	Empyema	χ²	p
Pulmonary abscess location
Right upper lobe	14	1	8.361	0.203
Right middle lobe	2	0
Right lower lobe	23	8
Left upper lobe	12	1
Left lower lobe	15	5
Bilateral pulmonary multiple lesions	16	3
Single pulmonary multiple lesions	19	7
Maximum diameter of the pulmonary abscess
≥5 cm	42	18	12.653	<0.0001
<5 cm	59	7
Multiple pulmonary abscesses
Yes	35	10	0.419	0.517
No	66	15
Multilocular pulmonary abscess
Yes	34	12	3.058	0.08
No	67	13
Cavity formation of the pulmonary abscess
Yes	60	17	1.018	0.313
No	41	8
Transpulmonary fissure abscess
Yes	18	11	15.546	<0.0001
No	83	14
Wall thickness of the pulmonary abscess
>5 mm	46	8	2.458	0.117
≤5 mm	55	17
Clear edge of the pulmonary abscess
Yes	30	7	0.046	0.83
No	71	18

Variables	B	SE	Wald	OR (95% CI)	p
Transpulmonary fissure abscess
Yes	2.209	0.751	8.654	9.102 (2.09-36.65)	0.003
No				1.00
Diabetes mellitus
Yes	2.204	0.734	9.014	9.066 (2.15-38.23)	0.003
No				1.00
Abscess >5 cm in diameter
>5 cm	2.197	0.723	9.245	8.998 (2.18-37.09)	0.002
≤5 cm				1.00
Pleuritic symptoms
Yes	1.686	0.692	5.938	5.395 (1.39-20.93)	0.015
No				1.00
White blood cell count (×10⁹/L)
>10	0.691	0.717	0.929	1.996 (0.49-8.15)	0.335
≤10				1.00

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E-mail: clinics@hc.fm.usp.br

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[1] ^*Corresponding authors. E-mails: cxd19790920@sina.com / tmhm@jnu.edu.cn