Mortality among patients with pleural effusion undergoing thoracentesis

Abstract

Background Of the 1.5 million people diagnosed with pleural effusion annually in the U.S., approximately 178,000 undergo thoracentesis. While it is known that malignant pleural effusion portends a poor prognosis, mortality of patients with nonmalignant effusions has not been well studied. Methods This prospective cohort study evaluated 308 patients undergoing thoracentesis. Chart review was performed to obtain baseline characteristics. The etiology of the effusions was determined using standardized criteria. Mortality was determined at 30-days and 1-year. Results 247 unilateral and 61 bilateral thoracenteses were performed. Malignant effusion had the highest 30-day (37%) and 1 year (77%) mortality. There was substantial patient 30-day and 1-year mortality with effusions due to multiple benign etiologies (29% and 55%), CHF (22% and 53%), and renal failure (14% and 57%). Patients with bilateral pleural effusion, relative to unilateral, were associated with higher risk of death at 30 days and 1 year (17% versus 47%; HR 2.58 CI [1.44–4.63] and 36% versus 69%; HR 2.32 CI [1.55–3.48]). Conclusions Patients undergoing thoracentesis for pleural effusion have high short and long-term mortality. Patients with malignant effusion had the highest mortality followed by multiple benign etiologies, CHF and renal failure. Bilateral pleural effusion is distinctly associated with high mortality.

Diagnostic yield of pleural fluid cytology in malignant effusions: an Australian tertiary centre experience

“…The minimum follow-up period was 18 months to capture all cases of difficult to diagnose malignant effusions, given an expected survival of less than 12 months in patients with MPE. 2 Patient details were submitted to a state-wide cancer registry (Victorian Cancer Registry) to verify diagnostic conclusions. Where data were missing or incomplete, clinical discussion with a respiratory physician experienced in the diagnosis of malignancy was used to determine if the cause was likely malignant, paramalignant or benign.…”

“…[1][2][3][4] Management following MPE detection is therefore palliative, with treatment goals shifted from potentially curative to symptom-based. The diagnosis carries a poor prognosis, with an average survival of 3-9 months and 1-year mortality of nearly 80%, depending on the primary tumour type.…”

“…The diagnosis carries a poor prognosis, with an average survival of 3-9 months and 1-year mortality of nearly 80%, depending on the primary tumour type. [1][2][3][4] Management following MPE detection is therefore palliative, with treatment goals shifted from potentially curative to symptom-based. 5 Timely identification of MPE allows patients with a limited lifespan to avoid unnecessary hospitalisation and often toxic treatment.…”

Lung Ultrasound Findings Detected During Inpatient Echocardiography Are Common and Associated With Short‐ and Long‐term Mortality

“…Pleural effusion on US imaging has been previously reported as a marker of clinical worsening in patients with congestive heart failure, having sensitivity of 76.6% and specificity of 98.6%, which outperforms physical examination and chest radiography . In studies of patients considered for thoracentesis, pleural effusions on chest radiography, whether caused by malignancy, congestive heart failure, renal disease, liver failure, infectious, multiple benign, and unknown etiologies were found to have high 30‐day and 1‐year mortality of 11% to 29% and 26% to 55%, respectively, a wide range that was attributable to the etiology. Our findings indicate a high prevalence of 20% and a similarly high mortality risk of pleural effusions when found by US, either alone (4.1% inpatient and 33.0% 1‐year mortality) or, even more ominous, in combination with B‐lines (16% inpatient and 49% 1‐year mortality).…”

Patient-Centered Outcomes Following Thoracentesis

“…Patients with pleural effusions who require thoracentesis are quite ill. We have previously demonstrated a high mortality rate in patients with malignant and benign effusions, 18 as well as in hospitalized patients undergoing thoracentesis. 19 The fact that 28.2% of patients in this study died and an additional 21.5% of those who were capable of providing follow-up information required an additional pleural intervention within 30 days of the initial thoracentesis emphasizes the need for aggressive management in this time period.…”