Department of Interventional Cardiology, St Bartholomew's Hospital, London, United Kingdom.
Department of Interventional Cardiology, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
Am J Cardiol. 2023 Jul 1;198:79-87. doi: 10.1016/j.amjcard.2023.04.034. Epub 2023 May 19.
In this study, we aimed to examine the diagnostic yield of pericardial fluid biochemistry and cytology and their prognostic significance in patients with percutaneously drained pericardial effusions, with and without malignancy. This is a single-center, retrospective study of patients who underwent pericardiocentesis between 2010 and 2020. Data were extracted from electronic patient records, including procedural information, underlying diagnosis, and laboratory results. Patients were grouped into those with and without underlying malignancy. A Cox proportional hazards model was used to analyze the association of variables with mortality. The study included 179 patients; 50% had an underlying malignancy. There were no significant differences in pericardial fluid protein and lactate dehydrogenase between the 2 groups. Diagnostic yield from pericardial fluid analysis was greater in the malignant group (32% vs 11%, p = 0.002); 72% of newly diagnosed malignancies had positive fluid cytology. The 1-year survival was 86% and 33% in nonmalignant and malignant groups, respectively (p <0.001). Of 17 patients who died within the nonmalignant group, idiopathic effusions were the largest group (n = 6). In malignancy, lower pericardial fluid protein and higher serum C-reactive protein were associated with increased risk of mortality. In conclusion, pericardial fluid biochemistry has limited value in determining the etiology of pericardial effusions; fluid cytology is the most important diagnostic test. Mortality in malignant pericardial effusions may be associated with lower pericardial fluid protein levels and a higher serum C-reactive protein. Nonmalignant pericardial effusions do not have a benign prognosis and close follow-up is required.
在这项研究中，我们旨在研究经皮引流的心包积液的生化和细胞学检查的诊断率及其在伴有和不伴有恶性肿瘤的心包积液患者中的预后意义。这是一项 2010 年至 2020 年期间进行的心包穿刺术的单中心回顾性研究。数据从电子患者记录中提取，包括手术信息、基础诊断和实验室结果。患者分为有基础恶性肿瘤和无基础恶性肿瘤两组。采用 Cox 比例风险模型分析变量与死亡率的关系。该研究共纳入 179 例患者，其中 50%有基础恶性肿瘤。两组间心包积液蛋白和乳酸脱氢酶无显著差异。恶性组心包积液分析的诊断率较高（32%比 11%，p=0.002）；新诊断的恶性肿瘤中 72%有阳性液细胞学检查。非恶性组和恶性组的 1 年生存率分别为 86%和 33%（p<0.001）。在非恶性组中 17 例死亡的患者中，特发性积液是最大的一组（n=6）。在恶性肿瘤中，较低的心包积液蛋白和较高的血清 C 反应蛋白与较高的死亡率相关。总之，心包积液生化检查在心包积液病因诊断方面价值有限；液细胞学检查是最重要的诊断性检查。恶性心包积液的死亡率可能与较低的心包积液蛋白水平和较高的血清 C 反应蛋白有关。非恶性心包积液的预后并非良性，需要密切随访。
