A0503 - Spontaneous Bacterial Empyema Is Associated With Increased Mortality and Liver Transplant Has Survival Benefit: A Systemic Review and Meta-Analysis

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Cristina I. Batarseh, MD

Lahey Hospital & Medical Center
Burlington, MA

Cristina I. Batarseh, MD, Karim T. Osman, MD, Neev N. Mehta, MD, MPH, Carol Spencer, , Amir A. Qamar, MD
Lahey Hospital & Medical Center, Burlington, MA

Introduction: Spontaneous bacterial empyema (SBE) is an infection of a pre-existing hepatic hydrothorax in patients with cirrhosis. It is rarely reported in the literature and the prognostic significance of SBE is not clearly illustrated. Liver Transplant (LT) has been suggested to have a survival benefit in patients with SBE, however, this has been limited by very small sample sizes. The aim of this study was to perform a systematic review and meta-analysis to evaluate the effect of SBE on mortality and the survival benefit that LT may provide.

Methods: A comprehensive search of several databases from each database’s inception to December 2021 was conducted. Studies included in the systematic review met the following inclusion criteria: adult patients, age >18 years, with a diagnosis of SBE. Manuscripts with < 5 patients were excluded from the study. The databases included Ovid MEDLINE®, Ovid EMBASE, and Google Scholar. Outcomes of interest were mortality and LT. Data synthesis was obtained using random-effects metanalysis and reported as risk ratio (RR) with 95 % confidence intervals (CIs). Heterogeneity was assessed using I2 statistics.

Results: After excluding duplicates, 257 unique titles were screened, ultimately including 3 retrospective cohort studies (Fig A). Study characteristics are shown in Table. Two studies reported mortality as an outcome, with a total of 34 patients with SBE compared to 909 patients without SBE. A total of 943 patients with liver cirrhosis were included. Of which, 34 (3.61%) patients had SBE. SBE is significantly associated with increased mortality (RR 1.66, 95% CI 1.06-2.59, I2=6%) (Fig B). All studies included reported outcomes of LT. 50 patients with SBE were included, of which 12 (24%) patients received a LT – none of which had died at last follow up. LT was significantly associated with reduced mortality (RR 0.13, 95% CI 0.03-0.58, I2=0%) (Fig C).

Discussion: Patients who develop SBE have a higher risk of mortality. LT may provide a survival benefit in patients with SBE. More studies with larger sample sizes are needed to validate our findings.

Figure: Figure1.
(A) Flowchart of the literature review.
(B) Forest plot showing that SBE was associated with increased mortality.
(C) Forest plot showing that LT was associated with lower mortality among patients with SBE.

Study (year); Location	Age	Females	Etiology of Cirrhosis; Alcohol/Viral/Other	MELD Score	MELD-Na Score	CTP classification: A/B/C (n)	CTP score
Osman (2022); United States of America	53.42 ± 10.11	3 (25.00%)	5/4/3	27.00 ± 5.75	28.92 ± 6.23	0/4/8	11.17 ± 1.85
Jiménez-Gutiérrez (2021); Mexico	58.00 (52.00– 64.00)	11 (50.00%)	3/5/14	16.00 (12.20– 17.80)	21.50 (17.20– 26.00)	0/10/12	0.00 (8.00– 11.00)
Xiol (1996); Spain	NR	NR	NR	NR	NR	NR	11 (10.00– 11.25)

Table: Table 1. Characteristics of patients with SBE in the literature.
Abbreviations: n, number; SBE, Spontaneous bacterial empyema; MELD-Na, Model for end-stage liver disease-Sodium; CTP, Child-Turcotte-Pugh; NR, not reported.

Disclosures:

Cristina Batarseh indicated no relevant financial relationships.

Karim Osman indicated no relevant financial relationships.

Neev Mehta indicated no relevant financial relationships.

Carol Spencer indicated no relevant financial relationships.

Amir Qamar indicated no relevant financial relationships.

Cristina I. Batarseh, MD, Karim T. Osman, MD, Neev N. Mehta, MD, MPH, Carol Spencer, , Amir A. Qamar, MD. A0503 - Spontaneous Bacterial Empyema Is Associated With Increased Mortality and Liver Transplant Has Survival Benefit: A Systemic Review and Meta-Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.