Chopra Amit, Hu Kurt, Gemoets Darren E, Judson Marc A
Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY.
Department of Medicine, Division of Pulmonary and Critical Care, and Sleep Medicine, Medical College of Wisconsin, Milwaukee.
Chest. 2025 Aug;168(2):531-538. doi: 10.1016/j.chest.2025.02.003. Epub 2025 Feb 13.
Previous clinical data suggest that the presence of a pleural effusion is associated with poor survival. However, these studies were limited by either a small sample size or lack of an adequate control group.
What is the impact of pleural effusion on survival in patients hospitalized with an admitting diagnosis of the 3 most common causes of pleural effusion: cancer, congestive heart failure, or pneumonia?
This is a retrospective analysis of US veterans hospitalized between January 1, 2000 and December 31, 2020. International Classification of Diseases codes were used to identify patients with an admitting diagnosis of congestive heart failure (CHF), pneumonia, or cancer. Patients were dichotomized as having a clinically significant pleural effusion (PE) when a PE drainage was performed or not. The latter group included both patients who had a PE that was not clinically significant (did not require drainage) and those who did not have a PE at the time of index hospitalization (NO-PE). All-cause mortality was compared between the PE and NO-PE cohorts.
We analyzed 34,707 patients in the PE group and 792,217 patients in the NO-PE group. Patients with PE had a significantly higher all-cause mortality compared with patients with no PE. The median survival time was significantly lower in PE group as compared with NO-PE group across all 3 diagnoses, CHF (PE, 1.51 years; 95% CI, 1.40-1.61 vs NO-PE, 3.23 years; 95% CI, 3.21-3.26), cancer (PE, 1.33 years; 95% CI, 1.27-1.39 vs NO-PE, 2.05 years; 95% CI, 2.02-2.08), and pneumonia (PE, 4.27 years; 95% CI, 3.94-4.61 vs NO-PE, 5.11 years; 95% CI, 5.06-5.15). The hazard ratios of all-cause mortality remained unchanged after adjusting for demographics and comorbidities.
The presence of a clinically significant PE was independently associated with higher all-cause mortality in patients with admitting diagnosis of CHF, cancer, and pneumonia. Clinicians and researchers should consider the association of CHF, cancer, and pneumonia with PEs when estimating the prognosis of individual patients and when assessing the survival of longitudinal cohorts.
既往临床数据表明胸腔积液的存在与较差的生存率相关。然而，这些研究存在样本量小或缺乏适当对照组的局限性。
胸腔积液对因三种最常见胸腔积液病因（癌症、充血性心力衰竭或肺炎）入院诊断的患者生存率有何影响？
这是一项对2000年1月1日至2020年12月31日期间住院的美国退伍军人的回顾性分析。使用国际疾病分类代码来识别因充血性心力衰竭（CHF）、肺炎或癌症入院诊断的患者。当进行胸腔积液引流或未进行引流时，患者被分为有临床显著胸腔积液（PE）组。后一组包括胸腔积液无临床意义（不需要引流）的患者以及在首次住院时没有胸腔积液的患者（无胸腔积液组）。比较胸腔积液组和无胸腔积液组的全因死亡率。
我们分析了胸腔积液组的34707例患者和无胸腔积液组的792217例患者。胸腔积液患者的全因死亡率显著高于无胸腔积液患者。在所有三种诊断（CHF、癌症和肺炎）中，胸腔积液组的中位生存时间均显著低于无胸腔积液组（CHF：胸腔积液组为1.51年；95%CI，1.40 - 1.61，无胸腔积液组为3.23年；95%CI，3.21 - 3.26；癌症：胸腔积液组为1.33年；95%CI，1.27 - 1.39，无胸腔积液组为2.05年；95%CI，2.02 - 2.08；肺炎：胸腔积液组为4.27年；95%CI，3.94 - 4.61，无胸腔积液组为5.11年；95%CI，5.06 - 5.15）。在调整人口统计学和合并症后，全因死亡率的风险比保持不变。
临床显著胸腔积液的存在与因CHF、癌症和肺炎入院诊断的患者较高的全因死亡率独立相关。临床医生和研究人员在估计个体患者的预后以及评估纵向队列的生存情况时，应考虑CHF、癌症和肺炎与胸腔积液的关联。
