Markatis Eleftherios, Perlepe Garifallia, Afthinos Andreas, Pagkratis Konstantinos, Varsamas Charalampos, Chaini Eleftheria, Papanikolaou Ilias C, Gourgoulianis Konstantinos I
Pulmonary Department, Corfu General Hospital, Corfu, Greece.
Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece.
Front Med (Lausanne). 2022 Feb 24;9:828783. doi: 10.3389/fmed.2022.828783. eCollection 2022.
Data regarding the prognostic significance of pleural effusion (PE) are scarce.
Explore the impact of PE on mortality among hospitalized patients.
Multicenter prospective observational study. Patients that underwent computed tomography (thorax and/or abdomen) and in which PE was detected, were admitted to the study. PE was classified by size on CT, anatomical distribution, diagnosis, and Light's criteria. Charlson comorbidity index (CCI), APACHE II, and SOFA score were calculated. Mortality at 1 month and 1 year were recorded.
Five hundred and eight subjects, mean age 78 years. Overall mortality was 22.6% at 1 month and 49.4% at 1 year. Bilateral effusions were associated with higher mortality than unilateral effusions at 1 month (32 vs. 13.3%, = 0.005) and large effusions with higher mortality than small effusions at 1 year (66.6 vs. 43.3%, < 0.01). On multivariate analysis age, CCI, APACHE II, SOFA score, and bilateral distribution were associated with short-term mortality, while long-term significant predictors were CCI, APACHE II, SOFA, and malignant etiology. Exudates (excluding MPE) exhibited a survival benefit at both 1 month and 1 year but due to the smaller sample, fluid characteristics were not included in the multivariate analysis.
Pleural effusion is a marker of advanced disease. Mortality is higher within the first month in patients with PEs related to organ failure, while patients with MPE have the worst long-term outcome. Independent predictors of mortality, apart from CCI, APACHE II, and SOFA scores, are age and bilateral distribution in the short-term, and malignancy in the long-term.
关于胸腔积液（PE）预后意义的数据稀少。
探讨PE对住院患者死亡率的影响。
多中心前瞻性观察性研究。对接受计算机断层扫描（胸部和/或腹部）且检测到PE的患者进行研究。根据CT上的积液大小、解剖分布、诊断及Light标准对PE进行分类。计算Charlson合并症指数（CCI）、急性生理与慢性健康状况评分系统II（APACHE II）及序贯器官衰竭评估（SOFA）评分。记录1个月和1年时的死亡率。
508名受试者，平均年龄78岁。1个月时总死亡率为22.6%，1年时为49.4%。双侧胸腔积液在1个月时的死亡率高于单侧胸腔积液（32%对13.3%，P = 0.005），大量胸腔积液在1年时的死亡率高于少量胸腔积液（66.6%对43.3%，P < 0.01）。多因素分析显示，年龄、CCI、APACHE II、SOFA评分及双侧分布与短期死亡率相关，而长期显著预测因素为CCI、APACHE II、SOFA及恶性病因。渗出液（不包括恶性胸腔积液）在1个月和1年时均显示出生存获益，但由于样本量较小，液体特征未纳入多因素分析。
胸腔积液是疾病进展的标志物。与器官衰竭相关的胸腔积液患者在第一个月内死亡率较高，而恶性胸腔积液患者的长期预后最差。除CCI、APACHE II和SOFA评分外，死亡率的独立预测因素在短期内为年龄和双侧分布，在长期内为恶性肿瘤。
