Spontaneous bacterial empyema in cirrhosis: A systematic review and meta-analysis

Table 1 Study details

Ref.	Year, country, study type	Total patients	Patients w/ PE	Patients w/ SBE	Patients w/ ascites	Patients with SBP	SBE w/o ascites	Age(mean)	Sex(m/f)	R PE	L PE	B/l PE	Treated patients	MELD score	CP score	Mortality
Xiol et al[8], 1996	1996, Spain, Prospective	120	120/120	16/120	95/120	14/18	6/24/						19/24		10.67 (1.20)
Chen et al[21], 2003	2003, Taiwan, Prospective	862	132/862	17/132	451/862	104/451	2/411	53.7 (13.2) [17n]	13/4[17n]	17/17					11.5 (1.6) [17n]
Chen et al[7], 2011	2011, Taiwan, Retrospective	3390	508/3390	81/508	1729/3390	44/1729	14/81	60.0 (12.8) [81n]	55/26 [81n]	60/81	21/81		58/81	20.5 (8.0)	9.7 (2.1)	31/81
Makhlouf et al[5], 2013	2012, Egypt, Prospective	901	61/901	16/61	45/901	9/45'	4/16'	51.1 (11.00) [16n]	15/1 [16n]	53/61	5/61	3/61			0 [CP A], 1 [CP B], 15 [CP C]//11.8 (1.3)	4/16
Mansour et al[22], 2013	2013, Egypt, Prospective	98	98/98	14/98	94/98	16/94	1/14'	69.7 (16.5) [14n]	8/6 [14n]	12/14	1/14	1/14		27.2 (5.7)
Emam et al[24], 2015	2015, Egypt, Prospective	322	322/322	46/322		108/322	0/46	56.76 (6.23) [46n]	30/16 [46n]	42/46	2/46	2/46			0 [CP A], 4 [CP B], 42 {CP C]
Abbasi et al[6], 2016	2016, Pakistan, Prospective	206	23/206	7/23'	152/206		5/23'	41.25 (13.593) [206n]	149/57 [206n]	18/23	3/23	2/23			62 [CP A], 61 [CP B], 83 [CP C]
Mohamed et al[23], 2017	2017, Egypt, Prospective	3000	70/3000	5/70'	70/3000	17/70

PE: Pleural effusion; SBE: Spontaneous bacterial empyema; SBP: Spontaneous bacterial peritonitis; R: Right; L: Left; B/l: Bilateral; Treated patients: Successfully treated patients; MELD: Model for end-stage liver disease; CP: Child-pugh.

Table 2 Spontaneous bacterial empyema diagnostic criteria

Ref.	Xiol et al[8], 1996	Chen et al[21], 2003	Chen et al[7], 2011	Makhlouf et al[5], 2013	Mansour et al[22], 2013	Emam et al[24], 2015	Abbasi et al[6], 2016	Mohamed et al[23], 2017
Year, country, study type	Spain, Prospective	Taiwan, Prospective	Taiwan, Retrospective	Egypt, Prospective	Egypt, Prospective	Egypt, Prospective	Pakistan, Prospective	Egypt, Prospective
SBE-diagnostic criteria	Positive PF culture and a PMN cell count > 250 cells/mm3 or negative PF culture, compatible clinical course, and a PF PMN > 500 cells/mm3; Exclusion of parapneumonic infections: no image of pneumonia on CXR or CT and evidence of pleural effusion before the infectious episode or PF transudate characteristics during infection	Positive PF culture and a PMN cell count > 250 cells/mm3 or PMN cell count > 500 cells/mm3; no pneumonia on CXR or CT; PF transudate characteristics during infection or evidence of pleural effusion before the infected episode	Positive PF culture and a PMN cell count > 250 cells/mm3 or, negative PF culture, PMN cell count > 500 cells/mm3; no evidence of pneumonia on CXR or CT and evidence of pleural effusion before the infectious episode or PF transudate characteristics during infection	Positive PF culture and a PMN count of 250 cells/mm3 or, if a negative culture, a PF PMN count of > 500 cells/mm3 and the absence of pneumonia or a contiguous infection process on CXR	Positive PF culture or, if negative, a PF PMN count > 500 cells/µL without radiographic evidence of pneumonia	Positive PF culture or, if negative, a PF PMN count > 500 cells/mm3 without radiographic evidence of pneumonia or a contiguous infection process on CXR	PF with PMN cell count > 500 cells/mm or positive culture with PMN cell count > 250 cells/mm3 with exclusion of a parapneumonic effusion	Positive PF culture and PMN count > 250 cells/mm3 or negative PF culture and PMN count > 500 cells/mm3; no evidence of pneumonia/parapneumonic effusion was observed on CXR or CT

SBE: Spontaneous bacterial empyema; SBP: Spontaneous bacterial peritonitis; PF: Pleural fluid; PMN: Polymorphonuclear leukocyte; CXR: Chest x ray; CT: Computerized tomography.