Inflammatory parameters after pleurodesis in recurrent malignant pleural effusions and their predictive value

Abstract

Recurrent pleural malignant effusion is a common problem which can be treated by inducing symphysis of the pleural sheets. Many different drugs administered into the pleural space can be used to achieve this. The drugs cause an inflammatory response, which in turn is believed to cause the symphysis. Comparatively little has been published on the degree of pleural inflammation and the systemic response and whether this will affect the outcome. The aim of this study was to describe the systemic inflammatory reaction following instillation of a chemical agent into the pleura and to investigate whether this had any predictive value for the outcome (i.e. the pleurodesis). The markers investigated were simple ones: erythrocyte sedimentation rate, C-reactive protein, and leukocyte count from venous blood samples, and the fever reaction. Eighty-nine prospective patients with malignant pleural effusion who underwent pleurodesis with either talc (48 patients) or quinacrine (41 patients) were included in the study. Symphysis was achieved in 82 patients (92 per cent) and all had a prominent transitional elevation of the inflammatory parameters. The unsuccessful attempts caused negligible or very small elevations, but due to the small numbers only the degree of fever after 8 and 48 h showed a statistically significant difference. In conclusion, pleurodesis causes a systemic inflammation and there is a tendency to a correlation between the success of pleurodesis and the degree of inflammation. High fever and high inflammatory parameters including CRP are due to this inflammatory response and do not indicate infection.

Chemical Pleurodesis Using Mistletoe Extraction (ABNOVAviscum^® <i>Injection</i>) for Malignant Pleural Effusion

“…after the pleurodesis is an expected response, hence it is advised not to administer antibiotics. 21) The two cases of SAE mentioned in results recovered without sequela. The changes in height, weight, blood pressure and pulse at the close-out visit compared to the screening visit were statistically significant, but these changes were not clinically significant.…”

Safety and Systemic Consequences of Pleurodesis with Three Different Doses of Silver Nitrate in Patients with Malignant Pleural Effusion

“…Pleurodesis is known to cause systemic inflammation [26], which can be monitored by CRP levels. We were not only able to demonstrate an increase CRP levels but also that this increase was dose dependent.…”

Mechanisms of Pleurodesis

“…A cause of concern is systemic inflammation, which apparently commonly occurs following instillation of almost all agents into the pleural space [50] and administration of talc-containing small particles (<10 mm in diameter) [51]. A large European multicenter study on the safety of talc poudrage including 558 patients with MPE treated with 4 g of large-particle talc (median diameter: 25.6 mm) found no cases of acute respiratory distress [52].…”