Pen Li1, Sarah Hosseini2, Tinghua Zhang3, Kayvan Amjadi4. 1. Division of Respirology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 2. Division of Respirology, Department of Medicine, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada. 3. Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 4. Division of Respirology, Department of Medicine, The Ottawa Hospital, General Campus, Ottawa, Ontario, Canada, kamjadi@toh.ca.
Abstract
BACKGROUND: Indwelling pleural catheters (IPCs) are an emerging therapy for persistent benign pleural effusions. IPCs may achieve pleurodesis and be removed. OBJECTIVES: We aimed to identify factors associated with higher pleurodesis rates and earlier IPC removal in benign pleural effusions. METHODS: We reviewed a database of IPCs inserted for nonmalignant pleural effusions in the period August 2007 to June 2017 in patients who underwent medical thoracoscopy (MT). Clinical, radiologic, and pleural fluid data were recorded. Logistic regression and Cox proportional hazards were used to assess the rate of and time to pleurodesis. RESULTS: 304 IPCs were reviewed. 52 were excluded from the pleurodesis analysis due to removal for another reason, or because of an eventual diagnosis of malignant disease. The overall pleurodesis rate was 74%, and median time to pleurodesis was 42 (IQR 18-93) days. Variables with increased pleurodesis rates in multivariate analysis include Eastern Cooperative Oncology Group performance status score of ≤2 (odds ratio [OR] 4.22, 95% confidence interval [CI] 1.75-10.16) and MT (OR 5.27, 95% CI 2.74-10.11). No variables were associated with reduced pleurodesis rates in multivariate analysis. Variables that predicted earlier removal in multivariate analysis included secondary pleural infection (hazard ratio [HR] 14.19, 95% CI 4.11-48.91), % eosinophils (HR 1.03, 95% CI 1.01-1.05), and connective tissue disease (HR 2.59, 95% CI 1.20-5.57). Variables that predicted delayed removal include pleural effusion above the hilum (HR 0.54, 95% CI 0.34-0.85), liver failure (HR 0.31, 95% CI 0.16-0.60), and heart failure (HR 0.32, 95% CI 0.20-0.52). CONCLUSIONS: IPCs are safe in benign effusions. Clinicians should consider numerous factors when predicting the rate of and time to pleurodesis.
BACKGROUND:Indwelling pleural catheters (IPCs) are an emerging therapy for persistent benign pleural effusions. IPCs may achieve pleurodesis and be removed. OBJECTIVES: We aimed to identify factors associated with higher pleurodesis rates and earlier IPC removal in benign pleural effusions. METHODS: We reviewed a database of IPCs inserted for nonmalignant pleural effusions in the period August 2007 to June 2017 in patients who underwent medical thoracoscopy (MT). Clinical, radiologic, and pleural fluid data were recorded. Logistic regression and Cox proportional hazards were used to assess the rate of and time to pleurodesis. RESULTS: 304 IPCs were reviewed. 52 were excluded from the pleurodesis analysis due to removal for another reason, or because of an eventual diagnosis of malignant disease. The overall pleurodesis rate was 74%, and median time to pleurodesis was 42 (IQR 18-93) days. Variables with increased pleurodesis rates in multivariate analysis include Eastern Cooperative Oncology Group performance status score of ≤2 (odds ratio [OR] 4.22, 95% confidence interval [CI] 1.75-10.16) and MT (OR 5.27, 95% CI 2.74-10.11). No variables were associated with reduced pleurodesis rates in multivariate analysis. Variables that predicted earlier removal in multivariate analysis included secondary pleural infection (hazard ratio [HR] 14.19, 95% CI 4.11-48.91), % eosinophils (HR 1.03, 95% CI 1.01-1.05), and connective tissue disease (HR 2.59, 95% CI 1.20-5.57). Variables that predicted delayed removal include pleural effusion above the hilum (HR 0.54, 95% CI 0.34-0.85), liver failure (HR 0.31, 95% CI 0.16-0.60), and heart failure (HR 0.32, 95% CI 0.20-0.52). CONCLUSIONS: IPCs are safe in benign effusions. Clinicians should consider numerous factors when predicting the rate of and time to pleurodesis.
Authors: Nikolaj Frost; Christoph Ruwwe-Glösenkamp; Matthias Raspe; Martin Brünger; Bettina Temmesfeld-Wollbrück; Norbert Suttorp; Martin Witzenrath Journal: BMJ Open Respir Res Date: 2020-01