Chest 2014 December 4 [Epub ahead of print] [Link]
Fysh ET, Bielsa S, Budgeon CA, Read CA, Porcel JM, Maskell NA, Lee YC.
The clinical course of patients with malignant pleural effusions (MPE) varies. The decision to undertake ‘definitive therapy’ (pleurodesis and/or indwelling pleural catheter [IPC]) for MPEs is decided on a case-by-case basis. Identifying factors that predict definitive therapy may help guide early initiation of treatment.
To identify clinical, laboratory and radiological predictors associated with clinicians’ prescription of definitive therapy for patients with MPE.
A multicentre, observational study over 55 months involving tertiary centres in Perth, Australia and in Lleida, Spain. Demographic, clinical, radiological, biochemical and histological data and the treatments received were recorded. Logistic regression was performed to determine the variables useful for predicting definitive therapy.
Data of 540 patients (365 from Perth and 184 from Lleida) were analysed; 537 fulfilled the criteria of a MPE. Definitive therapy was used in 288 (53.6%) patients: 199 received a pleurodesis and 89 an IPC. Univariate analysis of the combined cohort revealed definitive therapy was more likely if the effusion: has low pH, either as a continuous variable (OR 30.30, p<0.01) or with a pH cut-off of <7.2 (OR 2.09, p=0.03); was large (>50% of hemithorax) (OR 2.75, p<0.01); or was associated with mesothelioma (OR 1.83, p<0.01). Following multivariate analysis low pleural pH (OR 37.04, p<0.01), large effusions (OR 3.31, p<0.01) and increasing age (OR 1.02, p=0.01) were associated with the use of definitive therapy.
MPE patients with an effusion of low pleural fluid pH and large size on radiographs at first presentation are more likely to be treated with pleurodesis and/or IPC.