Italian multicentre study on the management of pLeural infection and empyema: IMPLE study

Pleural infection is a significant global healthcare challenge. While medical thoracoscopy (MT) is well-established for undiagnosed or malignant pleural effusion, its effectiveness in management of pleural infection lacks robust evidence. Moreover, data on the optimal timing of intervention in pleural infection are still scarce. To assess the probability of subsequent surgical referral in adult hospitalized patients with stage 2-3 pleural infection/empyema according to type and time of first procedures accounting for confounders. We conducted a multi-centre observational study. We retrospectively collected baseline demographic and clinical characteristics, RAPID score, type and time of first-line intervention. We evaluated their impact on probability of surgical referral, length of hospital stay (LOS) and 90-day mortality using multivariable logistic/multiple quantile regression models. We included 509 patients from 14 Italian centres (75.4% male, median (interquartile range) age 63 (49-76) years). Thoracentesis and chest tube placement were associated with a significant higher probability of subsequent surgical referral compared to MT (OR 6.0, 95% CI 1.8-20.6, p=0.004; OR 7.8, 95% CI 2.6-22.5, p<0.001, respectively). Additionally, chest drain insertion and upfront surgery were related to a longer LOS compared to MT (Regression Coefficient Estimates: 4.9; 95% CI 1.5-8.4; 5.2; 95% CI 1.0-9.5, respectively). Furthermore, a delayed intervention, regardless of type, resulted in a longer LOS. Our large real-world study provides valuable insights into management and outcomes of pleural infection, revealing different approaches among centres and suggesting that a timely MT, when adopted as first-line intervention, could reduce the probability of subsequent surgical referral, However, further prospective studies are required to confirm these findings.

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Publication Details

Journal
Respiratory Research
Published
2025-11-16
DOI
https://doi.org/10.1186/s12931-025-03391-7
Citations
1
Primary Topic
Pleural and Pulmonary Diseases
Type
article
Field-Weighted Citation Impact
1.52
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article

Italian multicentre study on the management of pLeural infection and empyema: IMPLE study

Laura Cirilli, Federico Mei, Elisabetta Balestro, Piero Emilio Balbo et al.
1 citations
Respiratory Research
Pleural and Pulmonary Diseases
1.52
article

Italian multicentre study on the management of pLeural infection and empyema: IMPLE study

Laura Cirilli, Federico Mei, Elisabetta Balestro, Piero Emilio Balbo, Lina Zuccatosta, Claudia Ravaglia, Pier Luigi Intiglietta, Donato Lacedonia, Paolo Carlucci, Francesca Gonnelli, Michele Sediari, Alberto Papi, Flavia Carle, V. Poletti, Gianfranco Puppo, Matteo Daverio, Alberto Fantin, M. Bonifazi, Claudio Sorino, C. Vancheri, Giovanna Elisiana Carpagnano, Marica Iommi, Michele Mondoni, Elena Paracchini, Rosaria Gesuita, V Pinelli, Raffaele Scala, Marco Trigiani, Mario Tamburrini, Giampietro Marchetti, Pietro Impellizzeri, A. DiMarcoBerardino
article en
1 citations

Abstract

Pleural infection is a significant global healthcare challenge. While medical thoracoscopy (MT) is well-established for undiagnosed or malignant pleural effusion, its effectiveness in management of pleural infection lacks robust evidence. Moreover, data on the optimal timing of intervention in pleural infection are still scarce. To assess the probability of subsequent surgical referral in adult hospitalized patients with stage 2-3 pleural infection/empyema according to type and time of first procedures accounting for confounders. We conducted a multi-centre observational study. We retrospectively collected baseline demographic and clinical characteristics, RAPID score, type and time of first-line intervention. We evaluated their impact on probability of surgical referral, length of hospital stay (LOS) and 90-day mortality using multivariable logistic/multiple quantile regression models. We included 509 patients from 14 Italian centres (75.4% male, median (interquartile range) age 63 (49-76) years). Thoracentesis and chest tube placement were associated with a significant higher probability of subsequent surgical referral compared to MT (OR 6.0, 95% CI 1.8-20.6, p=0.004; OR 7.8, 95% CI 2.6-22.5, p<0.001, respectively). Additionally, chest drain insertion and upfront surgery were related to a longer LOS compared to MT (Regression Coefficient Estimates: 4.9; 95% CI 1.5-8.4; 5.2; 95% CI 1.0-9.5, respectively). Furthermore, a delayed intervention, regardless of type, resulted in a longer LOS. Our large real-world study provides valuable insights into management and outcomes of pleural infection, revealing different approaches among centres and suggesting that a timely MT, when adopted as first-line intervention, could reduce the probability of subsequent surgical referral, However, further prospective studies are required to confirm these findings.

Respiratory ResearchVol. 26(1)
University of Foggia (IT), Marche Polytechnic University (IT), AOL (United States) (US), NATO Centre for Maritime Research and Experimentation (IT), University of Padua (IT), University of Ferrara (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Ospedale Maggiore (IT), Ospedali Riuniti di Foggia (IT), Azienda Ospedaliero Universitaria San Giovanni Battista (IT), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), Azienda Ospedaliero Universitaria Ospedali Riuniti (IT), Ospedale San Paolo (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Ospedale G.B. Morgagni - L.Pierantoni (IT), Ospedale Santa Maria della Misericordia di Udine (IT), Arcispedale Sant'Anna (IT), Policlinico Universitario di Catania (IT), Ospedale Pediatrico Giovanni XXIII (IT), Ospedale San Donato (IT), Azienda di Rilievo Nazionale ed Alta Specializzazione (IT), Ospedale Sant'Anna (IT), Azienda Usl Toscana Centro (IT), Azienda Ospedaliera Universitaria Pisana (IT), University of Florence (IT)
Openalex Percentile: Top 13%
Pleural and Pulmonary Diseases
1.52
DOIOpen Access PDFOpenAlex
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