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Original research
Epidemiology and prognostic factors of pleural empyema
  1. Antonio Bobbio1,
  2. Samir Bouam2,
  3. Jerome Frenkiel3,
  4. Kevin Zarca4,
  5. Ludovic Fournel1,5,
  6. Emelyne Canny1,
  7. Philippe Icard1,
  8. Raphaël Porcher6,
  9. Marco Alifano1,5
  1. 1 Thoracic Surgery, Hopital Cochin, Assistance Publique—Hopitaux de Paris, Paris, France
  2. 2 Unité d’Information Médicale, Hôpitaux Universitaires Paris Centre, Assistance Publique—Hopitaux de Paris, Paris, France
  3. 3 Délégation à la Recherche Clinique et à l'Innovation, Assistance Publique—Hopitaux de Paris, Paris, France
  4. 4 DRCI-URC Eco Ile-de-France (AP-HP), Assistance Publique—Hôpitaux de Paris, Paris, France
  5. 5 University of Paris Descartes Faculty of Medicine Paris Center, Paris, France
  6. 6 Inserm U1153, Paris, France
  1. Correspondence to Dr Antonio Bobbio, Thoracic Surgery, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris 75004, France; antonio.bobbio{at}


Background Infection of the pleural cavity invariably leads to hospitalisation, and a fatal outcome is not uncommon. Our aim was to study the epidemiology of pleural empyema on a nationwide basis in the whole population and in three subgroups of patients, namely post-lung resection, associated cancer and those with no surgery and no cancer.

Methods Data from patients aged ≥18 years hospitalised with a diagnosis of pleural infection in France between January 2013 and December 2017 were retrieved from the medical-administrative national hospitalisation database and retrospectively analysed. Mortality, length of stay and costs were assessed.

Results There were 25 512 hospitalisations for pleural empyema. The annual rate was 7.15 cases per 100 000 habitants in 2013 and increased to 7.75 cases per 100 000 inhabitants in 2017. The mean age of patients was 62.4±15.6 years and 71.7% were men. Post-lung resection, associated cancer and no surgery–no cancer cases accounted for 9.8%, 30.1% and 60.1% of patients, respectively. These groups were significantly different in terms of clinical characteristics, mortality and risk factors for length of stay, costs and mortality. Mortality was 17.1% in the whole population, 29.5% in the associated cancer group, 17.7% in the post-lung resection group and 10.7% in the no surgery–no cancer group. In the whole population, age, presence of fistula, higher Charlson Comorbidity Index (>3), alcohol abuse, arterial hypertension, hyperlipidaemia, atheroma, atrial fibrillation, performance status >3 and three subgroups of pleural empyema independently predicted mortality.

Conclusions Empyema is increasing in incidence. Factors associated with mortality are recent lung resection and associated diagnosis of cancer.

  • pleural disease
  • clinical epidemiology
  • empyema

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data are available upon reasonable request

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data are available upon reasonable request

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  • Contributors AB, SB and MA had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. LF and EC contributed to the study design. PI, RP, KZ and JF contributed to data analysis, and performed revision of the manuscript. AB and MA are responsible for study conception and design and contributed to manuscript writing and revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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