Introduction: Malignant pleural effusion is a common finding in patients with advanced cancer and is a frequent cause of dyspnea. Current guidelines indicate thoracentesis for symptomatic patients, while indwelling pleural catheters (IPC) are recommended for patients who develop pleural fluid re-accumulation. IPC maintenance, however, requires a significant level of financial and social support. This study aims to analyze potential influencing factors that may play a role in the decision for placing IPCs in patients with recurrent malignant pleural effusions.Methods: This study retrospectively collected baseline sociodemographic and laboratory data in patients who underwent thoracentesis for malignant pleural effusion from August 2016 to October 2021, and selected patients who presented with re-accumulation of pleural fluid within 30 days or had a pulmonary physician's note documenting that IPC is a potential management option. Of these selected patients (IPC candidates), we stratified patients who underwent IPC placement and those who did not, and performed statistical analysis between these 2 groups.Results: One hundred seventy-six patients who underwent thoracentesis were regarded as IPC candidates. Almost all baseline sociodemographic characteristics, including ethnicity (P = 0.637), sex (P = 0.655), and marital status (P = 0.773) were similar between the 2 groups, but significantly higher ECOG scores (P = 0.049) were noted in the IPC group. No statistically significant differences were noted in age, body mass index, platelet, PTT, international normalized ratio, creatinine, white blood cell, red blood cells, fluid protein, or fluid lactate dehydrogenase. Fluid albumin (P = 0.057) and serum neutrophil:lymphocyte ratio (P = 0.003) were significantly higher in patients without IPC placement.Conclusion: This study did not recognize any baseline sociodemographic factors that may contribute to the decision to place IPCs.
BACKGROUND:High venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that speci c clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE). METHODS:We performed a retrospective observational case-control study of 158 consecutive patients hospitalized in one of four Mount Sinai Hospitals with COVID-19 between March 1 and May 8, 2020, who received a Chest CT Pulmonary Angiogram (CTA) to diagnose a PE. We analyzed demographic, clinical, laboratory, radiological, treatment characteristics, and outcomes in COVID-19 patients with and without PE. RESULTS: 92 patients were negative (CTA-), and 66 patients were positive of PE (CTA+). CTA+ had a longer time from symptom onset to admission (7 days vs 4 days, p=0.05), higher admission biomarkers, notably D-dimer (6.87 vs 1.59, p<0.0001), troponin (0.015 vs 0.01, p=0.01), and peak D-dimer (9.26 vs 3.8, p=0.0008). Predictors of PE included time from symptom onset to admission (OR=1.11, 95% CI 1.03-1.20, p=0.008), and PESI score at the time of CTA (OR= 1.02, 95% CI 1.01-1.04, p= 0.008). Predictors of mortality included age (HR 1.13, 95% CI 1.04-1.22, p=0.006), chronic anticoagulation (13.81, 95% CI 1.24-154, p=0.03), and admission ferritin (1.001, 95% CI 1-1.001, p=0.01). CONCLUSIONS:In 158 hospitalized COVID-19 patients with respiratory failure evaluated for suspected PE, 40.8% patients had a positive CTA. We identi ed clinical predictors of PE and mortality from PE, which may help with early identi cation and reduction of PE-related mortality in patients with COVID-19.
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