Background & Aims

Spontaneous bacterial empyema (SBE) is defined as the spontaneous infection of hepatic hydrothorax. It is a rare infectious complication of portal hypertension in cirrhotic patients. The aim of this study was to evaluate the outcomes in patients diagnosed with SBE compared to cirrhotic patients without this complication.

Methods

We performed a retrospective cohort study of cirrhotic patients from a tertiary care center. The primary outcome was time to death or liver transplantation within one year after diagnosis of infection. We integrated three groups: patients with SBE (Group A), patients with spontaneous bacterial peritonitis (SBP, Group B), and cirrhotic patients without SBP/SBE (Group C), matched by age, MELD-Na score, and year of infection. Outcome was analyzed using a Cox regression model adjusting for cardiovascular risk factors and MELD-Na.

Results

Between January 1999 and February 2019, 4829 patients with cirrhosis were identified. Among them, 73 (1.5%) had a HH of whom 22 (30.1%) were diagnosed with SBE. Median age of the patients with SBE was 58 years (IQR 52–64), 11 patients (50%) were men, median Child Pugh score was 10 (IQR 8–11) and median MELD-Na was 21 (IQR 15–27). TFS was 9.1% (2/22), vs 41% (18/44) vs 52.2% (23/44) in Group A, B and C, respectively (log rank test p < 0.0011).

Conclusion

Our results suggest that patients with SBE had a lower one-year survival rate. Patients who develop SBE should have prompt referral for transplant evaluation. SBE might emerge as new indication that could benefit from MELD exception points.

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