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Original Research: Pulmonary Procedures |

Predictors of Clinical Use of Pleurodesis and/or Indwelling Pleural Catheter Therapy for Malignant Pleural EffusionPredicting Therapy in Malignant Pleural Effusion

Edward T. H. Fysh, MBBS; Silvia Bielsa, MD; Charley A. Budgeon, BSc (Hons); Catherine A. Read, RGN, BSc (Hons); Jose M. Porcel, MD, FCCP; Nick A. Maskell, DM, FCCP; Y. C. Gary Lee, MBChB, PhD, FCCP
Author and Funding Information

From Respiratory Medicine (Drs Fysh and Lee), Sir Charles Gairdner Hospital, Government of Western Australia, Perth, WA, Australia; Centre for Asthma, Allergy and Respiratory Research (Drs Fysh and Lee and Ms Read) and School of Medicine and Pharmacology (Drs Fysh and Lee), The University of Western Australia, Perth, WA, Australia; Pleural Diseases Unit (Drs Bielsa and Porcel), University Hospital Arnau de Vilanova, Lleida, Spain; Centre for Applied Statistics (Ms Budgeon), The University of Western Australia, Perth, WA, Australia; Department of Research (Ms Budgeon), Sir Charles Gairdner Hospital, Government of Western Australia, Perth, WA, Australia; and North Bristol Lung Centre (Dr Maskell), Southmead Hospital, Bristol University, Bristol, England.

CORRESPONDENCE TO: Y. C. Gary Lee, MBChB, PhD, FCCP, School of Medicine, The University of Western Australia, 533 Harry Perkins Bldg, QE II Medical Centre, Perth, WA 6009, Australia; e-mail: gary.lee@uwa.edu.au


FUNDING/SUPPORT: Dr Lee is a National Health and Medical Research Council (NHMRC) Career Development Fellow and receives project grant funding from the NHMRC, New South Wales Dust Disease Board (DDB), Sir Charles Gairdner Research Advisory Committee, Lung Institute of Western Australia (LIWA) Westcare grants, and the Cancer Council Western Australia. Dr Fysh received postgraduate scholarships from the NHMRC and LIWA to undertake this work and project funding from the DDB and Cancer Council Western Australia.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):1629-1634. doi:10.1378/chest.14-1701
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BACKGROUND:  The clinical course of patients with malignant pleural effusions (MPEs) varies. The decision to undertake “definitive therapy” (pleurodesis, indwelling pleural catheter [IPC], or both) for MPEs is decided on a case-by-case basis. Identifying factors that predict definitive therapy may help guide early initiation of treatment. The aim of the study was to identify clinical, laboratory, and radiologic predictors associated with clinicians’ prescription of definitive therapy for patients with MPE.

METHODS:  A multicenter, observational study was conducted over 55 months involving tertiary centers in Perth, Western Australia, Australia, and Lleida, Spain. Demographic, clinical, radiologic, biochemical, and histologic data and the treatments received were recorded. Logistic regression was performed to determine the variables useful for predicting definitive therapy.

RESULTS:  Data of 540 patients (365 from Perth and 184 from Lleida) were analyzed; 537 fulfilled the criteria of an MPE. Definitive therapy was used in 288 patients (53.6%): 199 received a pleurodesis and 89 an IPC. Univariate analysis of the combined cohort revealed that definitive therapy was more likely if the effusion has low pH, either as a continuous variable (OR, 30.30; P < .01) or with a pH cutoff of < 7.2 (OR, 2.09; P = .03); was large (> 50% of hemithorax) (OR, 2.75; P < .01); or was associated with mesothelioma (OR, 1.83; P < .01). Following multivariate analysis, low pleural pH (OR, 37.04; P < .01), large effusions (OR, 3.31; P < .01), and increasing age (OR 1.02, P = .01) were associated with the use of definitive therapy.

CONCLUSIONS:  Patients with MPE with an effusion of low pleural fluid pH and large size on radiographs at first presentation are more likely to be treated with pleurodesis and/or IPC.

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