Asya Eylem BOZTAS, Ayse Demet PAYZA, Arzu SENCAN
Current Thoracic Surgery - 2026;11(1):45-51
Background: This study aimed to investigate whether the disease phenotype of pleural effusion and empyema in children changed across the COVID-19 periods, by analyzing clinical, biochemical, and radiological parameters among culture negative pediatric patients. Materials and Methods: A retrospective analysis of 147 pediatric patients treated for thoracic empyema between 2012 and 2025 was conducted. Patients with current or previous SARS-CoV-2 infection were excluded. Patients were stratified into four groups: pre-COVID (<=2019), pandemic (2020-2021), early post-COVID (2022), and late post-COVID (>=2023). Worsening of the disease phenotype was assessed by the presence of lung abscess and necrotizing pneumonia. Demographic data, pleural fluid biochemistry (pH, glucose, lactate dehydrogenase (LDH)), and radiological findings were reviewed and compared. Results: The prevalence of empyema-associated lung abscesses showed a trend toward increase across periods, being higher during the pandemic (33.3%) and late post-COVID (15%) compared with the pre-COVID era (7.4%, p = 0.054). Necrotizing pneumonia also increased numerically, reaching 35% in the late post-COVID period. LDH levels were significantly higher in the escalation group (4614.54 +/- 4504.62 U/L) compared with the non-escalation group (2493.74 +/- 4415.49 U/L, p = 0.015). Oxygen requirement (p = 0.020), ICU admission (p < 0.001) and secondary intervention requirements differed significantly across periods (p = 0.046), with the highest rates observed in the early post-COVID group. Conclusions: In SARS-CoV-2 negative pediatric patients, empyema presenting in the post-pandemic period was associated with increased respiratory support requirements. These findings may reflect pandemic-related alterations in disease behavior and support earlier consideration of treatment escalation.
