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Disorders of the Pleura |

Pleural Effusion Characteristics and Mortality

Aparna Das, MD; Rahul Khosla, MD
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Veterans Affairs Medical Center, Washington, DC


Chest. 2013;144(4_MeetingAbstracts):511A. doi:10.1378/chest.1704793
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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 occur secondary to a variety of conditions, some of which are associated with significant mortality. Our aim was to evaluate the characteristics of effusions associated with higher mortality.

METHODS: This retrospective study included patients who underwent thoracentesis between March 2008 and January 2013 at the Washington DC Veterans Affairs Medical Center. Patient demographics, pleural fluid analysis, manometry data, final clinical diagnosis and mortality data were retrieved from the medical record.

RESULTS: 194 patients were included in the study. The majority were male (96.4%), aged between 25 and 93 years (mean 70 years). 59% were African American, reflecting the ethnic pattern of the population served by our institution. 114 patients had pleural manometry performed; of these, 18 had trapped lung, 33 had entrapped lung and 63 had normally expanding lung. Mortality rates in the trapped, entrapped and normal groups were 66.7%, 66.7% and 63.4% respectively (not statistically different). 101 patients had pleural fluid procalcitonin levels checked. Pleural fluid procalcitonin level was higher in the patients that died. Of all 194 patients, 135 effusions were exudates, and the remaining 59 were transudates. Mortality rates were similar in the exudate group (54.8%) and in the transudate group (52.5%). Comparing the group of patients who died with those who lived, there was no difference in the proportion of exudative effusions, nor in the number of effusions related to infection, heart failure or liver disease. There were more malignant effusions in the group that died.

CONCLUSIONS: Presence of trapped or entrapped lung has no bearing on mortality. Effusions that are exudates are not associated with higher mortality than those that are transudates. Malignant effusions, as expected were associated with higher mortality. Pleural fluid procalcitonin levels were higher in the group that died.

CLINICAL IMPLICATIONS: Pleural procalcitonin may have prognostic value as it was higher in the group that died.

DISCLOSURE: The following authors have nothing to disclose: Aparna Das, Rahul Khosla

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