Risk Factors of Empyema in Children in Suzhou, China

Background Respiratory tract infection is the most common disease in children, and pneumonia is the main disease. Pleural effusion is a common complication of pneumonia. Data show that up to 57% of hospitalized pneumonia patients have pleural effusion[1]. The parapneumonic pleural effusion (PPE) was divided into three categories: uncomplicated parapneumonic effusion (uppe), complex parapneumonic pleural effusion (CPPE) and parapneumonic empyema (PE)[2].Empyema is a kind of respiratory tract infectious disease with dangerous condition, rapid development and high mortality. Improper treatment can also develop into chronic empyema, and severe complications such as bronchopleural fistula, lung abscess and heart failure may occur. Therefore, timely identification of empyema, active and effective treatment and necessary invasive operation are very important to slow down the disease and reduce the mortality rate.Methods To analyzed the data of children with parapneumonic pleural effusion who were hospitalized in respiratory department of our hospital from January 2010 to December 2018. According to the results of pleural effusion, according to the light classification standard, they were divided into uncomplex parapneumonic effusion (UPPE group) and empyema group (PE group),Logistic regression was used to analyze the risk factors of empyema in children, and receiver operating characteristic (ROC) curve was drawn.Results A total of 63 children were included in the study, including 20 cases in UPPE group and 43 cases in PE group. Univariate analysis showed that children in PE group were younger than those in UPPE group [2.8 (1.1,5.83) vs. 6.54 (2.94,9.0), P < 0.05], clinical manifestations were more prone to shortness of breath (60.46% vs. 8.961, P < 0.05), wheezing (32.55% vs. 5%, P < 0.05), and C-reactive protein (CRP) in laboratory examination was higher [114.76 (54.19160.94) vs. 49.79 (23.68, 84.48), P < 0.05];In cellular immunity, CD3 + was lower (55.31 ± 14.15 vs. 65.76 ± 11.43, P < 0.05), CD3 + CD4 + was lower (27.32 ± 9.58 vs. 34.77 ± 7.99, P < 0.05), CD3-CD19 + was higher (31.61 ± 13.24 vs. 21.98 ± 9.63, P < 0.05), and more susceptible to bacterial infection (44.18% vs. 10%, P < 0.01).Multivariate logistic regression analysis showed that shortness of breath (or = 5.099,95% CI: 1.309-19.866) and elevated CRP (or = 1.013,95% CI: 1.001-1.026) were independent risk factors for empyema. The area under the ROC curve (AUC) of logistic regression model was 0.707 and 0.716, respectively, with moderate diagnostic accuracy.Conclusions The children with parapneumonic pleural effusion with shortness of breath and CRP > 89.41mg/l should be aware of empyema.