Kookoolis Anna S, Puchalski Jonathan T, Murphy Terrence E, Araujo Katy Lb, Pisani Margaret A
Pulmonary, Critical Care Medicine, Yale University School of Medicine, USA ; Interventional Program (IP), Yale University School of Medicine, USA.
Claude D. Pepper Older Americans Independence Center at Yale, Program on Aging, Yale University School of Medicine, USA.
J Pulm Respir Med. 2014 Jun;4(3):184. doi: 10.4172/2161-105X.1000184.
Each year in the United States an estimated 1.5 million people develop pleural effusions and approximately 178,000 thoracenteses (12%) are performed. While it has been established that malignant effusions are associated with increased mortality, the association between mortality and all-cause pleural effusions in a medical population has not been previously evaluated. Our objective was to evaluate associations between 30-day and 12-month all-cause mortality among patients with a pleural effusion.
All patients admitted to the medical service at Yale-New Haven Hospital during March 2011 were screened for pleural effusion. Pleural effusions were documented by the attending radiologist and the medical record was reviewed for admitting diagnosis, severity of illness and whether a thoracenteses was performed. The outcomes were 30-day and 12-month mortality after identification of the pleural effusion.
One-hundred and four patients admitted to the medical service had pleural effusions documented by the attending radiologist. At 30-days, 15% of these patients had died and by 12-months mortality had increased to 32%. Eleven (10.6%) of the 104 patients underwent a thoracenteses. Severity of illness and malignancy were associated with 30-day mortality. For 12-month mortality, associations were found with age, severity of illness, malignancy, and diagnosis of pulmonary disease. Although sample size precluded statistical significance with mortality, the hazard ratio for thoracenteses and 30-day mortality was protective, suggesting a possible short term survival benefit.
In hospitalized medical patients with a pleural effusion, age, severity of illness and malignancy or pulmonary disease were associated with higher 12-month mortality. Thoracenteses may provide a protective effect in the first 30 days, but larger studies are needed to detect a short-term survival benefit. The presence of a pleural effusion indicates a high risk of death, with 15% of patients dying within 30 days and 32% dead within one-year of hospital admission.
在美国，每年估计有150万人出现胸腔积液，大约进行了17.8万次胸腔穿刺术（占12%）。虽然已经确定恶性胸腔积液与死亡率增加有关，但此前尚未评估医疗人群中全因胸腔积液与死亡率之间的关联。我们的目标是评估胸腔积液患者30天和12个月全因死亡率之间的关联。
对2011年3月入住耶鲁 - 纽黑文医院内科的所有患者进行胸腔积液筛查。主治放射科医生记录胸腔积液情况，并查阅病历以确定入院诊断、疾病严重程度以及是否进行了胸腔穿刺术。结局指标为胸腔积液确诊后的30天和12个月死亡率。
内科收治的104例患者经主治放射科医生记录有胸腔积液。30天时，这些患者中有15%死亡，到12个月时死亡率增至32%。104例患者中有11例（10.6%）接受了胸腔穿刺术。疾病严重程度和恶性肿瘤与30天死亡率相关。对于12个月死亡率，发现与年龄、疾病严重程度、恶性肿瘤以及肺部疾病诊断有关。尽管样本量使死亡率无统计学意义，但胸腔穿刺术与30天死亡率的风险比具有保护作用，提示可能有短期生存益处。
在住院的内科胸腔积液患者中，年龄、疾病严重程度以及恶性肿瘤或肺部疾病与12个月较高死亡率相关。胸腔穿刺术可能在最初30天提供保护作用，但需要更大规模研究来检测短期生存益处。胸腔积液的存在表明死亡风险高，15%的患者在30天内死亡，32%在入院一年内死亡。
