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Risk factors for pleural effusion recurrence in patients with malignancy.

ABSTRACT: BACKGROUND AND OBJECTIVE:The main purpose of treatment in patients with malignant pleural effusion (MPE) is symptom palliation. Currently, patients undergo repeat thoracenteses prior to receiving a definitive procedure as clinicians are not aware of the risk factors associated with fluid recurrence. The primary objective of this study was to identify risk factors associated with recurrent symptomatic MPE. METHODS:Retrospective multicentre cohort study of patients who underwent first thoracentesis was performed. The primary outcome was time to fluid recurrence requiring intervention in patients with evidence of metastatic disease. We used a cause-specific hazard model to identify risk factors associated with fluid recurrence. We also developed a predictive model, utilizing Fine-Gray subdistribution hazard model, and externally validated the model. RESULTS:A total of 988 patients with diagnosed metastatic disease were included. Cumulative incidence of recurrence was high with 30% of patients recurring by day 15. On multivariate analysis, size of the effusion on chest X-ray (up to the top of the cardiac silhouette (hazard ratio (HR): 1.84, 95% CI: 1.21-2.80, P?=?0.004) and above the cardiac silhouette (HR: 2.22, 95% CI: 1.43-3.46, P?=?0.0004)), larger amount of pleural fluid drained (HR: 1.06, 95% CI: 1.04-1.07, P?

SUBMITTER: Grosu HB

PROVIDER: S-EPMC7315912 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Risk factors for pleural effusion recurrence in patients with malignancy.

Grosu Horiana B HB Molina Sofia S Casal Roberto R Song Juhee J Li Liang L Diaz-Mendoza Javier J Reddy Chakravarthy C Yarmus Lonny L Schiavo Dante D Simoff Michael M Johnstun Jared J Raid Abu-Awwad AA Feller-Kopman David D Lee Hans H Sahetya Sarina S Foley Finbar F Maldonado Fabien F Tian Xin X Noor Laila L Miller Russell R Mudambi Lakshmi L Saettele Timothy T Vial-Rodriguez Macarena M Eapen Gerogie A GA Ost David E DE

Respirology (Carlton, Vic.) 20180702 1

<h4>Background and objective</h4>The main purpose of treatment in patients with malignant pleural effusion (MPE) is symptom palliation. Currently, patients undergo repeat thoracenteses prior to receiving a definitive procedure as clinicians are not aware of the risk factors associated with fluid recurrence. The primary objective of this study was to identify risk factors associated with recurrent symptomatic MPE.<h4>Methods</h4>Retrospective multicentre cohort study of patients who underwent fir ...[more]

PMID: 29966171

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Project description:BackgroundCommunity-acquired pneumonia (CAP) patients usually present with parapneumonic pleural effusion (PPE), which complicates the treatment of pneumonia. This study aims to investigate the clinical characteristics and risk factors of elderly CAP patients hospitalised with PPE.MethodsThe clinical data of 132 elderly patients with CAP were retrospectively analysed. A total of 54 patients with PPE (PPE group) and 78 patients without PPE (NPPE group) were included in this study. Clinical data, laboratory examinations, treatments and other relevant indicators were collected. Univariate analysis and multivariate logistic regression analysis will be used to explore the possible risk factors for PPE.ResultsThe proportion of PPE in elderly patients with CAP was 40.9%. PPE patients were significantly more likely to be older, have comorbid neurological diseases, experience chest tightness, and have a lasting fever (P < 0.05). In contrast to NPPE patients, the total number of lymphocytes, serum albumin and blood sodium levels in the PPE group were significantly lower (P < 0.05). The blood D-dimer, C-reactive protein and CURB-65 score of PPE patients were significantly higher (P < 0.05) than those of NPPE patients. Multivariate logistic regression identified chest tightness (OR = 3.964, 95% CI: 1.254-12.537, P = 0.019), long duration of fever (OR = 1.108, 95%CI: 1.009-1.217, P = 0.03), low serum albumin (OR = 0.876, 95%CI: 0.790- 0.971, P = 0.012) or low blood sodium (OR = 0.896, 95%CI: 0.828-0.969, P = 0.006) as independently associated with the development of parapneumonic pleural effusion in the elderly.ConclusionThis study has identified several clinical factors, such as chest tightness, long duration of fever, low serum albumin, and low blood sodium, as risk factors for the development of pleural effusion in elderly patients with CAP. Early identification and prompt management of these patients can prevent inappropriate treatment and reduce morbidity and mortality.

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Risk factors for pleural effusion recurrence in patients with malignancy.

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Risk factors for pleural effusion recurrence in patients with malignancy.

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