Argento A Christine, Murphy Terrence E, Pisani Margaret A, Araujo Katy L B, Puchalski Jonathan
Division of Pulmonary, Allergy and Critical Care Medicine, Emory University, Atlanta, GA, USA.
Geriatrics section and the Program on Aging, Yale University, New Haven, CT, USA.
Pleura (Thousand Oaks). 2015 Jan-Dec;2. doi: 10.1177/2373997515600404. Epub 2015 Sep 1.
Pleural effusions impact over 1.5 million people annually in the United States and cause significant morbidity. Although therapeutic thoracentesis is associated with improvement in respiratory parameters, unanswered questions remain regarding its impact.
The purpose of this study was to investigate patient-centered outcomes, the need for additional pleural interventions, and mortality in the 30 days following thoracentesis.
This prospective observational cohort study was performed in a tertiary care academic medical center between December 2010 and December 2011. Adult patients referred for thoracentesis were offered enrollment. The following characteristics were evaluated both before and at 30 days postprocedure: dyspnea using modified BORG (mBORG), physical and mental quality of life (QoL) using the short form 12, and basic activities of daily living (BADLs). The primary outcomes included changes in these parameters 30 days after thoracentesis. Secondary outcomes included the need for additional pleural procedures and mortality within 30 days of the thoracentesis. Multivariable logistic regression was used for analysis.
Of the 284 patients who underwent thoracentesis, 80 (28.2%) died within 30 days of the procedure. Of the 163 patients comprising the analytical cohort, 35 (21.5%) patients required an additional pleural intervention within 30 days of the index procedure. Patients who survived more than 30 days following thoracentesis had a sustained improvement in dyspnea and mental QoL, but a minority had improvement in physical QoL or BADLs. Surviving patients demonstrated no significant associations between bilateral and unilateral thoracentesis, volume of fluid removed, or the etiology of the effusion (malignant vs nonmalignant) and improvement in QoL, dyspnea, and BADLs. Relative to nonmalignant etiology, the presence of a malignant effusion was strongly associated with the need for an additional intervention, yielding an odds ratio (95% confidence interval [95% CI]) of 16.92 (5.47-52.37). Patients with hepatic hydrothorax and infectious etiologies of their effusion were also likely to require additional pleural interventions.
The majority of patients in this cohort demonstrated sustained improvement in dyspnea and the mental aspect of QoL 30 days following thoracentesis, independent of the etiology and regardless of the volume of pleural fluid removed. A minority experienced sustained improvements in the physical aspect of QoL and BADLs. Although 28.2% of patients died within 30 days, nearly 1 in 5 survivors required an additional pleural intervention. These results emphasize the significant clinical impact, morbidity, and mortality experienced by patients who undergo thoracentesis for pleural effusions.
在美国，胸腔积液每年影响超过150万人，并导致严重的发病率。尽管治疗性胸腔穿刺术可改善呼吸参数，但其影响仍存在未解决的问题。
本研究的目的是调查以患者为中心的结局、额外胸腔干预的需求以及胸腔穿刺术后30天内的死亡率。
这项前瞻性观察队列研究于2010年12月至2011年12月在一家三级医疗学术医学中心进行。被转诊进行胸腔穿刺术的成年患者被邀请入组。在术前和术后30天评估以下特征：使用改良BORG量表（mBORG）评估呼吸困难，使用简短健康调查问卷12评估身体和心理生活质量（QoL），以及评估日常生活基本活动能力（BADLs）。主要结局包括胸腔穿刺术后30天这些参数的变化。次要结局包括额外胸腔操作的需求以及胸腔穿刺术后30天内的死亡率。采用多变量逻辑回归进行分析。
在接受胸腔穿刺术的284例患者中，80例（28.2%）在术后30天内死亡。在组成分析队列的163例患者中，35例（21.5%）在首次手术后30天内需要额外的胸腔干预。胸腔穿刺术后存活超过30天的患者在呼吸困难和心理生活质量方面持续改善，但少数患者在身体生活质量或日常生活基本活动能力方面有所改善。存活患者在双侧与单侧胸腔穿刺、抽出液体量或胸腔积液病因（恶性与非恶性）与生活质量、呼吸困难和日常生活基本活动能力改善之间未显示出显著关联。相对于非恶性病因，恶性胸腔积液的存在与额外干预的需求密切相关，优势比（95%置信区间[95%CI]）为16.92（5.47 - 52.37）。有肝性胸水和感染性病因胸腔积液的患者也可能需要额外的胸腔干预。
该队列中的大多数患者在胸腔穿刺术后30天呼吸困难和生活质量的心理方面持续改善，与病因无关，也与胸腔抽出液量无关。少数患者在生活质量的身体方面和日常生活基本活动能力方面持续改善。尽管28.2%的患者在30天内死亡，但近五分之一的幸存者需要额外的胸腔干预。这些结果强调了因胸腔积液接受胸腔穿刺术的患者所经历的重大临床影响、发病率和死亡率。
