Pleural Effusion in Acute Pulmonary Embolism: Characteristics and Relevance

Overview

Journal BMJ Open Respir Res

Date 2024 Nov 13

PMID 39537424

Authors

Nuria Rodriguez-Nunez

Francisco Gude

Lucia Ferreiro

Elisa Landin-Rey

Maria Carreiras-Cuina

Borja Otero

Maria Cruz Carbajales

Honorio J Martinez-Martinez

Carla Diaz-Louzao

Roi Soto-Feijoo

Juan Suarez Antelo

Maria E Toubes

Luis Valdes-Cuadrado

Affiliations

Soon will be listed here.

Abstract

Introduction: The characteristics and clinical relevance of pleural effusion (PLEF) in acute pulmonary embolism (APE) are not fully understood.

Methods: A single-centre, retrospective study was performed of patients admitted with APE classified according to the subsequent development or not of PLEF. A model was built to predict PLEF and its impact on 30-day all-cause mortality was investigated.

Results: A total of 1602 patients with APE were included (median age, 74 (61, 82) years; 674 men (42.1%); 382 (23.8%) with PLEF). PLEF was associated with a higher number of comorbidities (p=0.015); more peripheral APE (0.001); a higher frequency of pulmonary infarctions (p<0.001) and higher 30-day all-cause mortality (p=0.004) compared with those without PLEF. Bilateral PLEFs, as compared with unilateral, were associated with a higher number of comorbidities (p=0.009); more severe (simplified Pulmonary Embolism Severity Index ≥1; p<0.001) and higher 30-day all-cause mortality (p<0.001).On multivariate analysis, the presence of PLEF was associated with atrial fibrillation (OR 2.00; 95% CI 1.32 to 3.02), congestive heart failure (OR 3.00; 95% CI 1.81 to 5.00), pulmonary infarction (OR 3.19; 95% CI 2.38 to 4.29) and a Charlson index ≥3 (OR 1.59; 95% CI 1.03 to 2.45). The predictive model for PLEF had a moderate power of discrimination (area under the curve, AUC 0.76; 95% CI 0.73 to 0.79), whereas the predictive model for mortality showed a good predictive power (AUC 0.89; 95% CI 0.86 to 0.93). The presence of PLEF doubles the probability of death (OR 2.02; 95% CI 1.11 to 3.68). When PLEF is bilateral, the probability of death is four times higher, as compared with unilateral PLEF (OR 4.07; 95% CI 1.53 to 10.85; AUC 0.90; 95% CI 0.84 to 0.95).

Conclusions: A significant number of APE patients develop PLEF. The model showed a good power of discrimination for the prediction of mortality. The probability of death from APE doubles in the presence of PLEF. Patients with APE and concomitant bilateral PLEF have a fourfold higher risk of mortality, as compared with patients with concomitant unilateral PLEF.

References

Jimenez D, Aujesky D, Moores L, Gomez V, Lobo J, Uresandi F . Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010; 170(15):1383-9. DOI: 10.1001/archinternmed.2010.199. View

Yap E, Anderson G, Donald J, Wong C, Lee Y, Sivakumaran P . Pleural effusion in patients with pulmonary embolism. Respirology. 2008; 13(6):832-6. DOI: 10.1111/j.1440-1843.2008.01345.x. View

Porcel J, Madronero A, Pardina M, Vives M, Esquerda A, Light R . Analysis of pleural effusions in acute pulmonary embolism: radiological and pleural fluid data from 230 patients. Respirology. 2007; 12(2):234-9. DOI: 10.1111/j.1440-1843.2006.01026.x. View

Olgun Yildizeli S, Kasapoglu U, Arikan H, Cimsit C, Cimsit N, Aslan M . Pleural effusion as an indicator of short term mortality in acute pulmonary embolism. Tuberk Toraks. 2018; 66(3):185-196. DOI: 10.5578/tt.67203. View

Choi S, Cha S, Shin K, Lim J, Yoo S, Lee S . Clinical Relevance of Pleural Effusion in Patients with Pulmonary Embolism. Respiration. 2017; 93(4):271-278. DOI: 10.1159/000457132. View

Heymans M, van Buuren S, Knol D, van Mechelen W, de Vet H . Variable selection under multiple imputation using the bootstrap in a prognostic study. BMC Med Res Methodol. 2007; 7:33. PMC: 1945032. DOI: 10.1186/1471-2288-7-33. View

. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA. 1990; 263(20):2753-9. DOI: 10.1001/jama.1990.03440200057023. View

Lehnert P, Lange T, Moller C, Olsen P, Carlsen J . Acute Pulmonary Embolism in a National Danish Cohort: Increasing Incidence and Decreasing Mortality. Thromb Haemost. 2018; 118(3):539-546. DOI: 10.1160/TH17-08-0531. View

de Miguel-Diez J, Jimenez-Garcia R, Jimenez D, Monreal M, Guijarro R, Otero R . Trends in hospital admissions for pulmonary embolism in Spain from 2002 to 2011. Eur Respir J. 2014; 44(4):942-50. DOI: 10.1183/09031936.00194213. View

10.

Aviram G, Soikher E, Bendet A, Shmueli H, Ziv-Baran T, Amitai Y . Prediction of Mortality in Pulmonary Embolism Based on Left Atrial Volume Measured on CT Pulmonary Angiography. Chest. 2015; 149(3):667-75. DOI: 10.1378/chest.15-0666. View

11.

Findik S . Pleural effusion in pulmonary embolism. Curr Opin Pulm Med. 2012; 18(4):347-54. DOI: 10.1097/MCP.0b013e32835395d5. View

12.

Oz I, Altinsoy B, Serifoglu I, Sayin R, Buyukuysal M, Erboy F . Evaluation of right atrium-to-right ventricle diameter ratio on computed tomography pulmonary angiography: Prediction of adverse outcome and 30-day mortality. Eur J Radiol. 2015; 84(12):2526-32. DOI: 10.1016/j.ejrad.2015.08.019. View

13.

Zuin M, Rigatelli G, Turchetta S, Pasquetto G, Roncon L, Bilato C . Mortality Risk in Patients With Pulmonary Embolism With Pleural Effusion. Am J Cardiol. 2022; 179:122-123. DOI: 10.1016/j.amjcard.2022.06.028. View

14.

Zhang J, Zhou H, Aili A, Wang M, Shen Y, Yi Q . Prevalence and clinical significance of pleural effusion in patients with acute pulmonary embolism: a retrospective study. J Thorac Dis. 2021; 13(2):541-551. PMC: 7947497. DOI: 10.21037/jtd-20-2552. View

15.

Cha S, Shin K, Lee J, Hwangbo Y, Yoo S, Lee J . Clinical relevance of pulmonary infarction in patients with pulmonary embolism. Thromb Res. 2012; 130(3):e1-5. DOI: 10.1016/j.thromres.2012.03.012. View

16.

Deyo R, Cherkin D, Ciol M . Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992; 45(6):613-9. DOI: 10.1016/0895-4356(92)90133-8. View

17.

Liu M, Cui A, Zhai Z, Guo X, Li M, Teng L . Incidence of pleural effusion in patients with pulmonary embolism. Chin Med J (Engl). 2015; 128(8):1032-6. PMC: 4832941. DOI: 10.4103/0366-6999.155073. View

18.

Mahler D, Wells C . Evaluation of clinical methods for rating dyspnea. Chest. 1988; 93(3):580-6. DOI: 10.1378/chest.93.3.580. View

19.

Romero Candeira S, Hernandez Blasco L, Soler M, Munoz A, Aranda I . Biochemical and cytologic characteristics of pleural effusions secondary to pulmonary embolism. Chest. 2002; 121(2):465-9. DOI: 10.1378/chest.121.2.465. View

20.

Konstantinides S, Meyer G, Becattini C, Bueno H, Geersing G, Harjola V . 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European.... Eur Respir J. 2019; 54(3). DOI: 10.1183/13993003.01647-2019. View