Systemic Inflammatory Response to Different Sclerosing Agents as a Predictor of Pleurodesis Outcome

Abstract

Background/Aim: The objectives of this study were to evaluate systemic inflammation using different sclerosing agents and to estimate the prediction of systemic inflammation for the efficacy of pleurodesis. Patients and Methods: Ninetysix patients with recurrent and symptomatic malignant pleural effusion were enrolled in this retrospective study. We used serum C-reactive protein (CRP) levels, serum leukocyte counts and neutrophil-to-lymphocyte ratios (NLRs) as parameters of systemic inflammatory reactions. Evaluations of these parameters were performed before and 24 h after pleurodesis. Results: Pleurodesis was successful in 81 (84.4%) patients. The non-graded talc induced the highest changes in serum CRP levels, total white blood cell and neutrophil counts compared to other agents, while mitoxantrone induced the lowest. Graded talc and bleomycin induced the same levels of changes in serum CRP levels and serum leukocyte counts. The change in serum NLR was the same for all agent groups. Logistic regression confirmed that a change in serum CRP levels [odds ratio (OR)=0.92, p=0.002] and previous chemotherapy (OR=3.31, p=0.012) were independent predictors of pleurodesis efficacy. Conclusion: Pleurodesis agents induced a systemic inflammatory response at different levels. The change in serum CRP levels could be useful for predicting the success of pleurodesis.Approximately half of all patients with metastatic cancer develop malignant pleural effusion (MPE), which is likely to lead to a significant reduction in their quality of life, secondary to symptoms such as dyspnoea and cough (1). The main goals of MPE treatment are to decrease symptoms and improve quality of life (2). Pleurodesis with chemical agents is the most commonly used treatment for MPE (3). Talc is the most frequently used sclerosing agent (4). Nevertheless, talc pleurodesis can manifest some severe complications, such as hypoxia and acute respiratory distress syndrome (5-9). These complications are less frequent after the use of talc with large particles (10-13). Other agents, such as tetracycline derivates, silver nitrate, povidone-iodine, mitoxantrone, doxycycline and bleomycin have also been used, with variable efficacy and safety (14). The search for the most effective and safe agent for chemical pleurodesis is ongoing (15).Pleurodesis involves the induction of acute pleural inflammation, which, if sufficiently intense, progresses to pleural fibrosis that obliterates the pleural cavity and prevents the reaccumulation of fluid ( 16). The inflammatory mechanisms involved in this process are not yet fully understood. The manifested inflammatory reaction can be divided into a systemic and local response. The intensity of inflammatory activity in the pleural cavity may predict the efficacy of pleurodesis (17). However, there is a lack of research comparing systemic inflammation induced by different sclerosing agents.The objectives of this study were to evaluate the systemic inflammation induced by different sclerosing agents in patients with MPE and to ...

Pleurodesis

“…There are other weaker markers or contradictory reports such as short duration of tube drainage, use of thoracostomy tube, high glucose levels in the fluid, low pleural LDH, and low tumour burden during thoracoscopic evaluation [95,114]. Achieving a marked elevation of C--reactive protein is related to achieving a good response to pleurodesis, explained by mounting an adequate inflammatory response [115].…”