Criteria

Development of empyema in association with pneumonia[22]

Stage 1

  • Parapneumonic effusion (free-flowing exudate): low white cell count, lactate dehydrogenase (LDH) level less than half that in the serum, normal pH and glucose levels, no bacterial organisms.

Stage 2

  • Fibrinopurulent (bacterial invasion across the damaged lung epithelium with immune response): pH <7.2, glucose <40 mg/dL (<2.2 mmol/L), LDH >1000 IU/L. Called empyema if frank pus is found.

Stage 3

  • Chronic organizing (scar tissue formation): a fibrous pleural cortex begins to form, which may encase the lung, preventing re-expansion, impairing lung function, and creating a persistent pleural space with continuing potential for infection.

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