Clinical Predictors of Successful and Earlier Removal of Indwelling Pleural Catheters in Benign Pleural Effusions
| Autor: | Kayvan Amjadi, Sarah Hosseini, Tinghua Zhang, Pen Li |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Pleural effusion medicine.medical_treatment Thoracostomy 03 medical and health sciences Catheters Indwelling 0302 clinical medicine medicine Thoracoscopy Humans 030212 general & internal medicine Connective Tissue Diseases Pleurisy Device Removal Pleurodesis Aged Proportional Hazards Models Aged 80 and over Heart Failure medicine.diagnostic_test Proportional hazards model business.industry Hazard ratio Odds ratio Middle Aged Prognosis medicine.disease Confidence interval Surgery Pleural Effusion Logistic Models Treatment Outcome 030228 respiratory system Catheter-Related Infections Chest Tubes Heart failure Multivariate Analysis Female business Liver Failure |
| Zdroj: | Respiration. 98:239-245 |
| ISSN: | 1423-0356 0025-7931 |
| Popis: | Background: Indwelling pleural catheters (IPCs) are an emerging therapy for persistent benign pleural effusions. IPCs may achieve pleurodesis and be removed. Objectives: We aimed to identify factors associated with higher pleurodesis rates and earlier IPC removal in benign pleural effusions. Methods: We reviewed a database of IPCs inserted for nonmalignant pleural effusions in the period August 2007 to June 2017 in patients who underwent medical thoracoscopy (MT). Clinical, radiologic, and pleural fluid data were recorded. Logistic regression and Cox proportional hazards were used to assess the rate of and time to pleurodesis. Results: 304 IPCs were reviewed. 52 were excluded from the pleurodesis analysis due to removal for another reason, or because of an eventual diagnosis of malignant disease. The overall pleurodesis rate was 74%, and median time to pleurodesis was 42 (IQR 18–93) days. Variables with increased pleurodesis rates in multivariate analysis include Eastern Cooperative Oncology Group performance status score of ≤2 (odds ratio [OR] 4.22, 95% confidence interval [CI] 1.75–10.16) and MT (OR 5.27, 95% CI 2.74–10.11). No variables were associated with reduced pleurodesis rates in multivariate analysis. Variables that predicted earlier removal in multivariate analysis included secondary pleural infection (hazard ratio [HR] 14.19, 95% CI 4.11–48.91), % eosinophils (HR 1.03, 95% CI 1.01–1.05), and connective tissue disease (HR 2.59, 95% CI 1.20–5.57). Variables that predicted delayed removal include pleural effusion above the hilum (HR 0.54, 95% CI 0.34–0.85), liver failure (HR 0.31, 95% CI 0.16–0.60), and heart failure (HR 0.32, 95% CI 0.20–0.52). Conclusions: IPCs are safe in benign effusions. Clinicians should consider numerous factors when predicting the rate of and time to pleurodesis. |
| Databáze: | OpenAIRE |
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