Indwelling Tunneled Pleural Catheters for Refractory Hepatic Hydrothorax in Patients With Cirrhosis: A Multicenter Study.
Aged
Catheters, Indwelling
Female
Humans
Hydrothorax
/ diagnosis
Liver Cirrhosis
/ complications
Liver Transplantation
/ methods
Male
Middle Aged
Outcome and Process Assessment, Health Care
Palliative Care
/ methods
Pleurodesis
/ adverse effects
Postoperative Complications
/ classification
Preoperative Care
/ methods
Prosthesis Implantation
/ adverse effects
Retrospective Studies
United States
cirrhosis
hepatic hydrothorax
indwelling tunneled pleural catheter
pleural effusion
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
02
07
2018
revised:
03
08
2018
accepted:
15
08
2018
pubmed:
2
9
2018
medline:
21
12
2019
entrez:
2
9
2018
Statut:
ppublish
Résumé
The outcome of indwelling pleural catheter (IPC) use in hepatic hydrothorax (HH) is unclear. This study aimed to review the safety and feasibility of the IPC in patients with refractory HH. A retrospective multicenter study of patients with HH from January 2010 to December 2016 was performed. Inclusion criteria were refractory HH treated with an IPC and an underlying diagnosis of cirrhosis. Records were reviewed for patient demographics, operative reports, and laboratory values. The Kaplan-Meier method was used to estimate catheter time to removal. The Cox proportional hazard model was used to evaluate for independent predictors of pleurodesis and death. Seventy-nine patients were identified from eight institutions. Indication for IPC placement was palliation in 58 patients (73%) and bridge to transplant in 21 patients (27%). The median in situ dwell time of all catheters was 156 days (range, 16-1,978 days). Eight patients (10%) were found to have pleural space infection, five of whom also had catheter-site cellulitis. Two patients (2.5%) died secondary to catheter-related sepsis. Catheter removal secondary to spontaneous pleurodesis was achieved in 22 patients (28%). Median time from catheter insertion to pleurodesis was 55 days (range, 10-370 days). Older age was an independent predictor of mortality on multivariate analysis (hazard ratio, 1.05; P = .01). We present, to our knowledge, the first multicenter study examining outcomes related to IPC use in HH. Ten percent infection risk and 2.5% mortality were identified. IPC placement may be a reasonable clinical option for patients with refractory HH, but it is associated with significant adverse events in this morbid population.
Sections du résumé
BACKGROUND
The outcome of indwelling pleural catheter (IPC) use in hepatic hydrothorax (HH) is unclear. This study aimed to review the safety and feasibility of the IPC in patients with refractory HH.
METHODS
A retrospective multicenter study of patients with HH from January 2010 to December 2016 was performed. Inclusion criteria were refractory HH treated with an IPC and an underlying diagnosis of cirrhosis. Records were reviewed for patient demographics, operative reports, and laboratory values. The Kaplan-Meier method was used to estimate catheter time to removal. The Cox proportional hazard model was used to evaluate for independent predictors of pleurodesis and death.
RESULTS
Seventy-nine patients were identified from eight institutions. Indication for IPC placement was palliation in 58 patients (73%) and bridge to transplant in 21 patients (27%). The median in situ dwell time of all catheters was 156 days (range, 16-1,978 days). Eight patients (10%) were found to have pleural space infection, five of whom also had catheter-site cellulitis. Two patients (2.5%) died secondary to catheter-related sepsis. Catheter removal secondary to spontaneous pleurodesis was achieved in 22 patients (28%). Median time from catheter insertion to pleurodesis was 55 days (range, 10-370 days). Older age was an independent predictor of mortality on multivariate analysis (hazard ratio, 1.05; P = .01).
CONCLUSIONS
We present, to our knowledge, the first multicenter study examining outcomes related to IPC use in HH. Ten percent infection risk and 2.5% mortality were identified. IPC placement may be a reasonable clinical option for patients with refractory HH, but it is associated with significant adverse events in this morbid population.
Identifiants
pubmed: 30171863
pii: S0012-3692(18)32281-5
doi: 10.1016/j.chest.2018.08.1034
pmc: PMC6435906
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
546-553Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR002649
Pays : United States
Informations de copyright
Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Références
Biomed Res Int. 2013;2013:295153
pubmed: 24222902
Ann Am Thorac Soc. 2016 Jun;13(6):862-6
pubmed: 27015392
Eur J Gastroenterol Hepatol. 2001 May;13(5):529-34
pubmed: 11396532
Thorax. 2014 Oct;69(10):959-61
pubmed: 24343783
Respiration. 2010;80(4):348-52
pubmed: 20145382
Hepatol Int. 2009 Dec;3(4):582-6
pubmed: 19669710
Chest. 2004 Jul;126(1):142-8
pubmed: 15249455
Am J Gastroenterol. 2010 Mar;105(3):635-41
pubmed: 19904245
Respiration. 2013;86(2):155-73
pubmed: 23571767
Transplantation. 1998 Oct 15;66(7):956-62
pubmed: 9798717
Am J Gastroenterol. 1986 Jul;81(7):566-7
pubmed: 3717119
JAMA. 2012 Jun 13;307(22):2383-9
pubmed: 22610520
Respiration. 2018;96(4):330-337
pubmed: 29991046
Chest. 2013 Nov;144(5):1597-1602
pubmed: 23828305
Ann Am Thorac Soc. 2016 Feb;13(2):212-6
pubmed: 26598967
J Bronchology Interv Pulmonol. 2013 Oct;20(4):299-303
pubmed: 24162111
Chest. 2017 Mar;151(3):626-635
pubmed: 27845052
Transplantation. 1997 Nov 15;64(9):1300-6
pubmed: 9371672
Chest. 2019 Feb;155(2):307-314
pubmed: 29990479
Curr Opin Pulm Med. 2003 Jul;9(4):261-5
pubmed: 12806237
Medicine (Baltimore). 2014 May;93(3):135-142
pubmed: 24797168
Chest. 2006 Feb;129(2):362-8
pubmed: 16478853
J Vasc Interv Radiol. 2002 Apr;13(4):385-90
pubmed: 11932369