Study of Predictors for Successful Pleurodesis in Patients with Malignant Pleural Effusion
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- Category: Vol. 85, March 2017
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Study of Predictors for Successful Pleurodesis in Patients with Malignant Pleural Effusion, TALAT A. ARAFA, MOHAMMED R. MORSI, SAMEH F. MAKLED and MUSTAFA M. GOMAA
Abstract
Background: Most of the Malignant Pleural Effusions (MPEs) are the result of metastasis to the pleura from other sites. The primary tumors were, in the decreasing order of frequency: Lung (37%), breast (17%), unknown site (10%), lymphoma (9%), gastrointestinal (8%), ovary (7%) and me-sothelioma (3%).Management of malignant effusions depends on palliation of dyspnea and prevention of the reaccumulation of pleural fluid to provide the highest possible quality of life, regardless of the need for other treatment modalities. Pleur-odesis is defined as the symphysis between the visceral and parietal pleural surfaces; its function is to prevent accumulation of either air or fluid into the pleural space.
Effusions of malignant origin are the most common indication for pleurodesis. Unfortunately, pleurodesis fails in 10-40% of patients with recurrence of pleural fluid and dyspnea. Because pleurodesis is associated with considerable cost and morbidity, the identification of patients who will experience an unsuccessful pleurodesis would be desirable.
Objective: To assess the values of the initial pleural fluid LDH, C Reactive Protein (CRP), cholesterol, Adenosine Deaminase (ADA) and PH characteristics on pleurodesis outcome in patients with Malignant Pleural Effusions (MPEs).
Methods: The current study was conducted at the Chest Departments of El-Hussein and Saied Galal University Hos-pitals in the period between December 2015 and May 2016. 30 patients with malignant pleural effusion were included in this study. 15 males and 15 females with age ranging between 38 and 75 years (mean age 58.3±9.54) were included. They were diagnosed finally by pleural fluid cytology and/or CT guided biopsy or tissue biopsy (Abrams or thoracoscopic biopsied). Informed consent was obtained from all patients enrolled in the study. 21 patients (70%) showed successful pleurodesis, while the remaining 9 patients (30%) showed failed pleurodesis.
Results: Pleural fluid values of proteins and LDH has no significant implication on the results of pleurodesis, while values of pleural fluid glucose, CRP, cholesterol and ADA (adenosine deaminase) significantly affect the results of pleurodesis as patient with high pleural fluid glucose, low