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Background and Aims: Empyema thoracis remains a major clinical problem with substantial morbidity, especially in patients with underlying comorbidities and delayed presentation. Failure of tube thoracostomy often leads to prolonged hospital stay and the need for surgical intervention. This study aimed to evaluate the clinico-demographic profile, radiological, microbiological, and procedural factors influencing outcomes of empyema thoracis managed primarily with tube thoracostomy, and to identify predictors of poor outcome at six months. Methods: This single-centre observational study included patients diagnosed with empyema thoracis and managed with intercostal chest drain insertion. Demographic data, personal history, clinical symptoms, comorbidities, body mass index, laboratory parameters, microbiological findings, and radiological characteristics were recorded. Tube-related variables, complications, duration of drainage, and need for surgical intervention were documented. Outcomes at six months were categorized as good or poor. Associations between explanatory variables and outcomes were analysed using Chi-square and Fisher’s exact tests. Results: The mean age of participants was 38.12 years, with male predominance. Comorbidities such as diabetes, lung disease, prior tuberculosis, low BMI, and HIV infection were significantly associated with poor outcomes (p<0.05). Prolonged symptom duration, extended drain duration, pleural thickening, absent lung expansion, bronchopleural fistula, and air leak at the ICD site strongly predicted poor outcomes. Tuberculous and pyogenic pleural fluid positivity were associated with higher failure rates of tube thoracostomy. At six months, 60% achieved good outcomes with tube drainage, while others required decortication or had persistent disease. Conclusion: Empyema outcomes are strongly influenced by comorbidities, disease severity, microbiological etiology, and tube-related factors. Early diagnosis, prompt drainage, careful monitoring for complications, and timely surgical referral are essential to improve outcomes. Key words: Empyema thoracis; Tube thoracostomy; Bronchopleural fistula; Pleural thickening; Decortication; Treatment outcome