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Disorders of the Pleura |

Pleural Effusions and 30-Day Mortality

Erin Murphy, MD; Margaret Pisani, MD; Terrence Murphy, PhD; Katy Araujo, MPH; Anna Kookoolis, MS; Angela Argento, MD; Jonathan Puchalski, MD
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Yale University, New Haven, CT


Chest. 2013;144(4_MeetingAbstracts):507A. doi:10.1378/chest.1703023
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Abstract

SESSION TITLE: Pleural Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Pleural effusions are diagnosed in 1.5 million people annually. Congestive heart failure is the most common single etiology, but many patients have multiple factors contributing to the development of their effusion. While it is known that pleural effusion in patients with malignancy is a poor prognostic feature, the mortality of patients with nonmalignant effusions is not well determined.

METHODS: A prospective IRB-approved study evaluated 312 patients undergoing thoracentesis by the Interventional Pulmonary program at Yale-New Haven Hospital between December 2010 and December 2011. Thoracentesis was performed using ultrasound guidance. Chart review was performed to obtain baseline demographics and comorbidities. The etiology of the effusions was determined by medical record review and the results of pleural fluid analysis using standardized criteria. Mortality was determined at 30 days.

RESULTS: Two-hundred and fifty unilateral and 62 bilateral thoracenteses were performed. The mean age of our population was 67.5+14.4 years. There were no procedure-related deaths. Age and gender were not associated with 30-day mortality. Patients had a mean of 4.5+1.9 comorbidities and the number of comorbidities was not associated with 30-day mortality. Patients with malignant effusions had a 35% mortality at 30 days, whereas the mortality for nonmalignant conditions was as follows: heart failure (22%), renal failure (14%), liver failure (7%) and infection-related effusions (11%). Patients who had multiple nonmalignant etiologies of their effusions had a 26% mortality. Patients who had unilateral effusions had an18% mortality whereas those with bilateral effusions had a 34% mortality.

CONCLUSIONS: Patients who undergo thoracentesis for pleural effusions have high 30-day mortality. More than one-third of patients with bilateral or malignant effusions were dead at 30 days. Having multiple nonmalignant etiologies, including combinations of heart failure, liver or renal disease, was also associated with high mortality.

CLINICAL IMPLICATIONS: These data aid in determining mortality prognosis in various causes of pleural effusions.

DISCLOSURE: The following authors have nothing to disclose: Erin Murphy, Margaret Pisani, Terrence Murphy, Katy Araujo, Anna Kookoolis, Angela Argento, Jonathan Puchalski

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