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. 2021 Jun 17;57(6):2003546.
doi: 10.1183/13993003.03546-2020. Print 2021 Jun.

Epidemiology of pleural empyema in English hospitals and the impact of influenza

David T Arnold  1 , Fergus W Hamilton  2 , Tim T Morris  3 , Tim Suri  4 , Anna Morley  5 , Vicky Frost  4 , Ian B Vipond  4 , Andrew R Medford  5 , Rupert A Payne  6 , Peter Muir  4 , Nick A Maskell  5
Affiliations

Epidemiology of pleural empyema in English hospitals and the impact of influenza

David T Arnold et al. Eur Respir J. .

Abstract

Pleural empyema represents a significant healthcare burden due to extended hospital admissions and potential requirement for surgical intervention. This study aimed to assess changes in incidence and management of pleural empyema in England over the past 10 years and the potential impact of influenza on rates.Hospital Episode Statistics data were used to identify patients admitted to English hospitals with pleural empyema between 2008 and 2018. Linear regression was used to analyse the relationship between empyema rates and influenza incidence recorded by Public Health England. The relationship between influenza and empyema was further explored using serological data from a prospective cohort study of patients presenting with pleural empyema.Between April 2008 and March 2018 there were 55 530 patients admitted with pleural empyema. There was male predominance (67% versus 33%), which increased with age. Cases have increased significantly from 4447 in 2008 to 7268 in 2017. Peaks of incidence correlated moderately with rates of laboratory-confirmed influenza in children and young adults (r=0.30). For nine of the 10 years studied, the highest annual point incidence of influenza coincided with the highest admission rate for empyema (with a 2-week lag). In a cohort study of patients presenting to a single UK hospital with pleural empyema/infection, 24% (17 out of 72) had serological evidence of recent influenza infection, compared to 7% in seasonally matched controls with simple parapneumonic or cardiogenic effusions (p<0.001).Rates of empyema admissions in England have increased steadily with a seasonal variation that is temporally related to influenza incidence. Patient-level serological data from a prospective study support the hypothesis that influenza may play a pathogenic role in empyema development.

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Conflict of interest statement

Conflict of interest: D.T. Arnold has nothing to disclose. Conflict of interest: F.W. Hamilton has nothing to disclose. Conflict of interest: T.T. Morris has nothing to disclose. Conflict of interest: T. Suri has nothing to disclose. Conflict of interest: A. Morley has nothing to disclose. Conflict of interest: V. Frost has nothing to disclose. Conflict of interest: I.B. Vipond has nothing to disclose. Conflict of interest: A.R. Medford has nothing to disclose. Conflict of interest: R.A. Payne has nothing to disclose. Conflict of interest: P. Muir has nothing to disclose. Conflict of interest: N.A. Maskell has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Age distribution of empyema episodes split by sex.
FIGURE 2
FIGURE 2
Trend of incidence of empyema April 2008 to April 2018 (split by age categories).
FIGURE 3
FIGURE 3
Influenza incidence per 100 000 and empyema count, April 2008 to April 2018.
See this image and copyright information in PMC

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