Determinants of pleurodesis success – does pleural fluid biochemical features matter?

S. Silva*^a (Dr), J. Eusébio^a (Dr), M. Santos^a (Dr), V. Martins^a (Dr), M. Aguiar^a (Dr), F. Todo Bom^a (Dr)

^a Interventional Pulmonology Unit, Pulmonology Department, Hospital Beatriz Ângelo, Loures, PORTUGAL

* sofiamcampossilva@gmail.com

Background

Recurrent pleural effusion (PE) causes a significant morbidity with dyspnea and impairment in quality of life. In many patients, PE recurs despite the best possible treatment of the underlying condition and an effective palliative approach is required.

Methods

Retrospective analysis of all pleurodesis in a Pulmonology Unit of a secondary hospital, between 2012 and 2021.

All pleurodesis were performed in an inpatient setting using talc slurry via chest tube (CT). We collected demographic data, biochemical and cytological analysis of pleural fluid (PF), etiology, CT size and duration, efficacy, presence of congestive heart failure, nonsteroidal anti-inflammatory and corticosteroids medication and procedure complications. Efficacy was defined as non-recurrence of PE that required new pleural intervention.

Data were analyzed in IBM SPSS Statistics® version 22.

Results

A total of 109 patients were enrolled. 52.3% were female and mean age was 71.9 ± 12 years old. Light's criteria identified 92.7% as exudates. 6.4% were recurrent non-malignant PE, caused by heart failure or cirrhosis. None of these patients recurred after pleurodesis.

93.6% were malignant PE, although only 75.5% had positive cytology. Among malignant PE, 52% were caused by lung cancer and 11.8% by breast cancer. 20.2% recurred after pleurodesis.

We registered 12.8% complications, the most frequent was fever (4.6%).

Pleurodesis efficacy was higher when LDH in PF was <1000 UI/L (p-value 0.013) and when CT ≥ 20Fr were used (p-value 0.035). Recurrence is more likely the longer CT is maintained (p-value 0.039).

Conclusion

Pleurodesis is a safe and efficient procedure. Our results show that LDH >1000 UI/L as well as the longer need of CT drainage might be predictors of recurrence, which may alert us that these patients may need an alternative treatment, eventually chronic CT. Results favor the use of larger bore CT. Prospective studies are needed.

Disclosure of funding source(s): none