Clinical predictors of successful and earlier pleurodesis with a tunnelled pleural catheter in malignant pleural effusion: a cohort study

Article Figures & Tables

Table 1:

Baseline demographic and clinical characteristics at insertion of tunnelled pleural catheter

Characteristic	No. (%) of catheters^* n = 1071
Patient age, yr, mean ± SD	68 ± 12
Patient sex
Male	437 (40.8)
Female	634 (59.2)
Side of catheter
Left	466 (43.5)
Right	605 (56.5)
ECOG Scale of Performance Status grade
0	1 (0.1)
1	43 (4.0)
2	173 (16.2)
3	395 (36.9)
4	459 (42.8)
Baseline dyspnea index, mean ± SD	2.2 ± 1.9
Transition dyspnea index, mean ± SD	6.4 ± 1.6
Fluid drained, L, mean ± SD	1.6 ± 0.77
Positive findings on cytologic examination	399 (37.2)
Baseline pleural effusion above hilum	585 (54.6)
Hydropneumothorax after drainage	228 (21.3)
Medical thoracoscopy at catheter insertion	158 (14.8)

Table 2:

Rates of pleurodesis and days to pleurodesis by tumour type in univariate analysis

Tumour type	No. (%) of catheters with pleurodesis	OR (95% CI)	Days to pleurodesis, median (IQR)	p value
Non–small-cell lung cancer (n = 384)	151 (39.3)	0.77 (0.60–1.00)	42 (25–77)	0.5
Breast (n = 213)	90 (42.2)	0.95 (0.70–1.28)	65 (35–144)	< 0.001
Ovarian (n = 83)	56 (67.5)	2.95 (1.83–4.75)	41 (29–66)	0.3
Lymphoma (n = 76)	48 (63.2)	2.39 (1.47–3.87)	48 (29–100)	0.4
Gastrointestinal (n = 66)^*	12 (18.2)	0.27 (0.14–0.51)	35 (28–46)	0.4
Mesothelioma (n = 53)	32 (60.4)	2.07 (1.18–3.63)	39 (16–87)	0.4
Other (n = 196)	75 (38.3)	0.77 (0.56–1.06)	42 (21–62)	0.9
Total (n = 1071)	464 (43.3)	–	44 (26–90)	–

Table 3:

Univariate logistic regression analysis of other demographic and clinical factors predicting rates of pleurodesis

Variable	OR (95% CI)
Age	0.994 (0.985–1.004)
ECOG Scale of Performance Status grade ≤ 2	5.078 (3.639–7.087)
Medical thoracoscopy	5.435 (3.639–8.041)
Pleural infection	2.645 (0.792–8.837)
Chest radiologic data
Hydropneumothorax	1.091 (0.812–1.464)
Lung expansion ≤ 80%	0.887 (0.696–1.131)
Pleural fluid analysis
pH	1.499 (0.882–2.547)
Protein level	1.070 (1.054–1.086)
Albumin level	1.147 (1.118–1.178)
Lactate dehydrogenase level	1 (1–1)
Glucose level	0.993 (0.943–1.046)
Erythrocyte count	1 (1–1)
Total nucleated cell count	1 (1–1)
% neutrophils	0.990 (0.984–0.997)
% lymphocytes	1.016 (1.011–1.021)
% monocytes	0.996 (0.990–1.002)
% mesothelial cells	0.999 (0.988–1.011)
% eosinophils	1.045 (1.015–1.076)
% other cells on cell count	0.986 (0.979–0.993)
Positive findings on cytologic examination	0.797 (0.620–1.025)

Note: CI = confidence interval, ECOG = Eastern Cooperative Oncology Group, OR = odds ratio.

Table 5:

Multivariate logistic regression of clinical factors predicting rates of pleurodesis

Variable	OR (95% CI)
Lymphoma	3.49 (1.93–6.33)
Ovarian cancer	2.93 (1.68–5.11)
Gastrointestinal cancer	0.41 (0.19–0.87)
ECOG Scale of Performance Status grade ≤ 2	2.79 (1.79–4.34)
Medical thoracoscopy	2.21 (1.28–3.85)
Hydropneumothorax	0.62 (0.41–0.94)
Protein level	1.03 (1.01–1.06)
Albumin level	1.07 (1.03–1.12)
% eosinophils	1.04 (1.00–1.07)
% other cells	0.98 (0.97–0.99)

Note: CI = confidence interval, ECOG = Eastern Cooperative Oncology Group, OR = odds ratio.

Table 6:

Optimal threshold values by receiver operating characteristic curve analysis of continuous variables predicting pleurodesis

Variable^*	Threshold value	Area under the curve (95% CI)	Sensitivity (95% CI)	Specificity (95% CI)	PPV (95% CI)	NPV (95% CI)	PLR	NLR
Protein level	≥ 44 g/L	0.69 (0.65–0.72)	0.45 (0.41–0.50)	0.81 (0.77–0.84)	0.63 (0.57–0.68)	0.67 (0.64–0.71)	2.35	0.68
Albumin level	≥ 25 g/L	0.71 (0.68–0.75)	0.47 (0.42–0.52)	0.82 (0.79–0.85)	0.65 (0.59–0.71)	0.69 (0.65–0.72)	2.64	0.65
% eosinophils	≥ 6%	0.55 (0.52–0.58)	0.09 (0.07–0.12)	0.96 (0.94–0.97)	0.61 (0.49–0.73)	0.60 (0.57–0.63)	2.22	0.95
% other cells	0%	0.55 (0.51–0.58)	0.60 (0.55–0.65)	0.47 (0.43–0.51)	0.44 (0.40–0.49)	0.62 (0.57–0.67)	1.12	0.86

Note: CI = confidence interval, NLR = negative likelihood ratio, NPV = negative predictive value, PLR = positive likelihood ratio, PPV = positive predictive value.
↵* All tests were performed on pleural fluid.

Table 7:

Multivariate Cox regression of clinical factors predicting days to pleurodesis

Variable	HR (95% CI)
Ovarian cancer	1.48 (1.06–2.08)
Breast cancer	0.61 (0.46–0.81)
Medical thoracoscopy	1.45 (1.10–1.92)
Hydropneumothorax with ≤ 80% lung expansion	0.55 (0.38–0.80)
Protein level	1.03 (1.01–1.04)
% eosinophils	1.02 (1.00–1.04)
% other cells	0.99 (0.98–1.00)

Table 8:

Complications related to tunnelled pleural catheter

Complication	No. (%) of catheters
Loculation needing fibrinolytic	45 (4.2)
Catheter dislodged	16 (1.5)
Pleural infection	13 (1.2)
Symptomatic reexpansion pulmonary edema	13 (1.2)
Leak at catheter site	7 (0.6)
Cellulitis	6 (0.6)
Pain necessitating removal	4 (0.4)
Mechanical failure	3 (0.3)
Catheter plugged	3 (0.3)
Tumour seeding	2 (0.2)
Broken catheter valve	2 (0.2)
Syncope	1 (0.1)
Catheter fractured at removal	1 (0.1)