Clinical predictors of successful and earlier pleurodesis with a tunnelled pleural catheter in malignant pleural effusion: a cohort study

Autor:	Lynn Kachuik, Tinghua Zhang, Kayvan Amjadi, Alison Graver, Lorraine Cake, Pen Li, Sarah Hosseini, Sunita Mulpuru
Rok vydání:	2018
Předmět:	medicine.medical_specialty medicine.diagnostic_test Hydropneumothorax Performance status business.industry Research medicine.medical_treatment Hazard ratio General Medicine Odds ratio medicine.disease Surgery 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Thoracoscopy medicine Malignant pleural effusion 030212 general & internal medicine business Chest radiograph Pleurodesis
Zdroj:	CMAJ Open
ISSN:	2291-0026
Popis:	Background Tunnelled pleural catheters used to treat malignant pleural effusions may achieve pleurodesis. We aimed to identify factors associated with higher pleurodesis rates and earlier catheter removal. Methods We retrospectively reviewed a prospective database of tunnelled pleural catheters inserted consecutively between May 2006 and June 2013 for confirmed malignant pleural effusion. The cohort included patients who underwent medical thoracoscopy. Clinical, radiologic and pleural fluid data were recorded. We used logistic regression and Cox regression to assess rates of and days to pleurodesis, respectively. Results We analyzed data for 1071 tunnelled pleural catheters in 956 patients. Increased rates of pleurodesis were associated with lymphoma (odds ratio [OR] 3.49, 95% confidence interval [CI] 1.93-6.33), ovarian cancer (OR 2.93, 95% CI 1.68-5.11), Eastern Cooperative Oncology Group Scale of Performance Status grade 2 or less (OR 2.79, 95% CI 1.79-4.34), medical thoracoscopy (OR 2.21, 95% CI 1.28-3.85), protein level (OR 1.03, 95% CI 1.01-1.06), albumin level (OR 1.07, 95% CI 1.03-1.12) and percent eosinophils (OR 1.04, 95% CI 1.00-1.07). Reduced rates of pleurodesis were associated with gastrointestinal cancers (OR 0.41, 95% CI 0.19-0.87), hydropneumothorax on the postdrainage chest radiograph (OR 0.62, 95% CI 0.41-0.94) and percent other cells on cell count (OR 0.98, 95% CI 0.97-0.99). Earlier pleurodesis was associated with ovarian cancer (hazard ratio [HR] 1.48, 95% CI 1.06-2.08), medical thoracoscopy (HR 1.45, 95% CI 1.10-1.92), protein level (HR 1.03, 95% CI 1.01-1.04) and percent eosinophils (HR 1.02, 95% CI 1.00-1.04). Delayed pleurodesis was associated with breast cancer (HR 0.61, 95% CI 0.46-0.81), hydropneumothorax with 80% or less lung expansion (HR 0.55, 95% CI 0.38-0.80) and percent other cells (HR 0.99, 95% CI 0.98-1.00). Interpretation Clinicians should consider numerous factors to predict the probability of and timing to pleurodesis with tunnelled pleural catheters.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d83c7952adf1b7837a9e612845188410 https://doi.org/10.9778/cmajo.20170163 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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