PURPOSE: to evaluate the value of biochemical parameters of the pleural aspirate in predicting success of chemical pleurodesis in adult patients with malignant pleural effusion.
METHODS: 30 adult patients who presented with malignant pleural effusion. In all patients, multiple sessions of closed pleurocentesis were carried out followed by insertion of an intercostal tube. The pleural aspirate was then sent for Glucose, PH, and LDH. When the intercostal tube drainage reached 150 mls per day, pleurodesis was then done either by using Tetracycline (group A= 15 patients), or Bleomycin (group B-15 patients). All patients were then followed up for success of the pleurodesis process.
RESULTS: Within one month of follow-up, rates of clinical response to treatment in group A (Tetracycline) were successful in 6 cases (40 %); versus 11 cases in group B (73.3 %). Complete response (CR) occurred in 3 of group A cases (20 %); versus 11 cases (73.3 %) in group B; whereas partial response (PR) occurred in 3 cases of group A; versus 6 cases (40 %) of group B; and treatment failure (TF) occurred in 9 of group A cases (60 %) versus 4 (26.6 %) of group B case. The success of the pleurodesis process was closely-associated to a higher glucose and PH levels together with a low LDH level in the pleural fluid. Treatment failure (TF) due to a more-aggressive malignant involvement occurred with very low PH and Glucose value and a markedly-elevated or high LDH result.
CONCLUSION: The success of pleurodesis is usually higher when the pleural fluid PH and glucose levels are high & the LDH level is low. A low PH, and glucose level, and a high LDH in MPEs have a poorer outcome of pleurodesis.
CLINICAL IMPLICATIONS: chemical pleurodesis in adult patients with malignant pleural effusion.
DISCLOSURE: Sherif Elsayed, None.