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Abstract: Poster Presentations |

PLEURAL EFFUSION AS THE INITIAL MANIFESTATION OF MALIGNANCY IN AN INNER CITY HOSPITAL FREE TO VIEW

Shahram Khorrami, MD*; Muhammad Iqbal, MD; Veenu Garewal, MD; Joe G. Zein, MD; Sanjay Chawla, MD
Author and Funding Information

SUNY Downstate Medical Center, Brooklyn, NY


Chest


Chest. 2007;132(4_MeetingAbstracts):618b-619. doi:10.1378/chest.132.4_MeetingAbstracts.618b
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Abstract

PURPOSE: A pleural effusion may be the initial manifestation of malignancy. We sought to determine the etiology of the malignancy and clinical course of patients with this presentation.

METHODS: Adult patients presenting from January 2001 to December 2006 at Kings County Hospital with a malignant pleural effusion (MPE) as first manifestation of cancer were identified from discharge diagnoses. Clinical data and outcome variables were extracted from the medical records. Data are presented as mean ± SD or median and 95 CI. Comparisons between groups were done using the Student t-Test for continuous variables. Categorical variables were compared using the Pearson chi-square test. A p value <0.05 was considered statistically significant.

RESULTS: Thirty-two patients (20 women and 12 men) were identified. Mean age at presentation was 62 ± 13 years. They included more women (63%) than men (37%). Adenocarcinoma was the most encountered pathological diagnosis (84%), which had 94% sensitivity, 28% specificity and 80% negative predictive value for diagnosing lung cancer as the primary site. Seventeen patients had adenocarcinoma and 1 had squamous cell carcinoma of lung, 4 had adenocarcinoma with unknown primary, 2 had adenocarcinoma of breast, 2 had T cell lymphoma and the remainder from other origins. Three patients required MICU admission. Eight patients died after diagnosis, before being discharged, with a mean survival of 49±41 days. Mortality was associated with a higher WBC and absolute neutrophil count of pleural fluid. An absolute neutrophil count above 320 (/cu mm) had 74% sensitivity and 79 % specificity in predicting hospital mortality and poor prognosis. Mortality correlated with WBC count (r2=0.74; p<0.05), fluid LDH (r2=0.73; p<0.05) and inversely with fluid glucose level (r2=0.68; p<0.05).

CONCLUSION: Adenocarcinoma of the lung was the most common cause of MPE as initial manifestation (53%). Early hospital mortality and a worse prognosis were associated with a higher pleural fluid WBC and absolute neutrophil count.

CLINICAL IMPLICATIONS: Adenocarcinoma is the most likely diagnosis in MPE as first manifestation. A high absolute neutrophil count can predict early hospital mortality.

DISCLOSURE: Shahram Khorrami, No Financial Disclosure Information; No Product/Research Disclosure Information

Wednesday, October 24, 2007

12:30 PM - 2:00 PM


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