Outcomes of Patients with and without Malignancy Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion
Abstract
:1. Introduction
2. Methods
2.1. Patient Population
2.2. Percutaneous Pericardiocentesis Procedures
2.3. Definition
2.4. Study Endpoint
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics of the Study Patients
3.2. The Type of Malignancy and Associated Mortality Rate
3.3. Univariable and Multivariable Cox Regression Analyses of Predictors of One-Year Mortality
3.4. Kaplan–Meier Curves Showing 1-Year All-Cause Mortality Data of the Two Groups and Subgroups of the Malignancy Population
4. Discussion
4.1. Poor Prognosis in Malignant PE
4.2. The Predictors of Mortality in the Cancer Population with Malignant PE
4.3. Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | All Patients (N = 502) | Non-Malignancy (N = 225) | Malignancy (N = 277) | p Value |
---|---|---|---|---|
Demographic | ||||
Age (years) | 63 ± 13.4 | 67 ± 15.3 | 59 ± 12.3 | <0.001 |
Male gender (%) | 309 (61.6) | 150 (66.7) | 159 (57.4) | 0.034 |
Medical history | ||||
Diabetes mellitus (%) | 126 (25.1) | 74 (32.9) | 52 (18.8) | <0.001 |
Hypertension (%) | 213 (42.4) | 140 (62.2) | 73 (26.4) | <0.001 |
Connective disease (%) | 10 (2.0) | 7 (3.1) | 3 (1.1) | 0.121 |
Liver cirrhosis (%) | 28 (5.6) | 12 (5.3) | 16 (5.8) | 0.848 |
CAD (%) | 88 (17.5) | 74 (32.9) | 14 (5.1) | <0.001 |
Heart failure (%) | 15 (3.0) | 11 (5.2) | 4 (1.7) | 0.062 |
ESRD (%) | 48 (9.6) | 37 (16.4) | 11 (4.0) | <0.001 |
Thyroid dysfunction (%) | 72 (26.5) | 33 (14.7) | 39 (14.1) | 0.898 |
Prior history of pericardiocentesis (%) | 36 (7.2) | 9 (4.0) | 27 (9.7) | 0.014 |
Lab data | ||||
WBC (1000/μL) | 10.3 ± 5.7 | 9.6 ± 4.0 | 10.8 ± 6.8 | 0.010 |
Hgb (g/dL) | 11.1 ± 2.1 | 11.0 ± 2.2 | 11.2 ± 2.1 | 0.153 |
PLT (1000/μL) | 227 ± 111 | 220 ± 108 | 233 ± 112 | 0.221 |
Creatinine (excluded ESRD) (mg/dL) | 1.36 ± 1.24 | 1.64 ± 0.66 | 1.16 ± 0.76 | <0.001 |
LDH (mg/dL) | 267 ± 267 | 242 ± 246 | 284 ± 288 | 0.016 |
Glucose (mg/dL) | 147.3 ± 57.7 | 141.7 ± 57.5 | 151.7 ± 57.6 | 0.158 |
Clinical symptoms | ||||
asystematic | 69 (13.7) | 41 (18.2) | 28 (10.1) | 0.009 |
dyspnea | 345 (68.7) | 136 (60.4) | 209 (75.5) | <0.001 |
tachycardia | 408 (81.3) | 163 (72.4) | 245 (88.4) | <0.001 |
shock | 191 (38.0) | 92 (40.9) | 99 (35.7) | 0.267 |
Pleural effusion | ||||
Combined | 354 (70.5) | 136 (60.4) | 218 (78.7) | <0.001 |
Bilateral side | 177 (35.3) | 63 (28.0) | 114 (41.2) | 0.001 |
Only left side | 133 (26.5) | 64 (87.7) | 69 (66.3) | |
Only right side | 44 (8.8) | 9 (12.3) | 35 (33.7) | |
Ascites | 69 (13.7) | 37 (16.4) | 32 (11.6) | 0.120 |
Echo | ||||
Cardiac tamponade (%) | 416 (82.9) | 170 (75.6) | 246 (88.8) | <0.001 |
Low voltage on ECG | 173 (34.5) | 57 (25.4) | 116 (42.0) | <0.001 |
Pericardial effusion | ||||
The color | <0.001 | |||
Fresh red | 143 (28.5) | 66 (29.3) | 77 (27.8) | |
Dark red | 178 (35.5) | 66 (29.3) | 112 (40.4) | |
Yellow | 139 (27.7) | 60 (26.7) | 79 (28.5) | |
Turbid | 42 (8.4) | 33 (14.7) | 9 (3.2) | |
Lab data | ||||
WBC (/μL) | 1470 ± 1476 | 1435 ± 1322 | 1530 ± 1745 | 0.442 |
LDH (mg/dL) | 566 ± 572 | 462 ± 474 | 666 ± 674 | 0.758 |
Glucose (mg/dL) | 108 ± 108 | 115 ± 117 | 96 ± 98 | 0.082 |
The mean of drainage amount (mL) | 376.1 ± 253.1 | 356.9 ± 274.8 | 389.0 ± 237.0 | 0.194 |
Surgery of pericardial periotoneal window (%) | 30 (6.0) | 9 (4.1) | 21 (7.7) | 0.129 |
Complications of pericardiocentesis (%) | 5 (1.0) | 4 (1.8) | 1 (0.4) | 0.179 |
Clinical outcomes | ||||
In-hospital mortality (%) | 163 (32.5) | 17 (7.6) | 66 (23.8) | <0.001 |
One-year mortality (%) | 198 (39.4) | 42 (18.7) | 156 (56.3) | <0.001 |
Median of F/U duration (days) | 206 ± 222 | 630 ± 636 | 106 ± 107 | <0.001 |
Variables | All Patients (N = 277) |
---|---|
Original site | |
Lung (%) | 138 (49.8) |
Breast (%) | 30 (10.8) |
GI tract (%) | 30 (10.8) |
Hepatology (%) | 8 (2.9) |
Gynecology (%) | 6 (2.2) |
Thymoma (%) | 4 (1.4) |
Leukemia and lymphoma (%) | 17 (6.1) |
Nasopharyngeal and oropharyngeal (%) | 46 (16.6) |
Nephrology (%) | 1 (0.4) |
Urology (%) | 2 (0.7) |
Cardiology (%) | 1 (0.4) |
Unknown (%) | 12 (4.3) |
Double cancer (%) | 18 (6.5) |
Metastasis | 211 (76.2) |
Lung/pleural | 181 (65.3) |
Pericardial | 110 (39.7) |
Extrathoracic | 125 (45.1) |
Recurrence | 46 (16.6) |
Prior history of chemotherapy and/or radiotherapy | 164 (59.2) |
Malignancy in pericardial effusion | 98 (35.4) |
Univariate Analysis | Multivariate Analysis | |||||
---|---|---|---|---|---|---|
Variables | HR | 95% CI | p value | HR | 95% CI | p value |
Age | 0.994 | 0.984−1.003 | 0.188 | |||
Male gender | 0.884 | 0.666−1.173 | 0.393 | |||
Diabetes mellitus | 0.781 | 0.559−1.092 | 0.149 | |||
Hypertension | 0.497 | 0.368−0.673 | <0.001 | |||
Connective disease | 0.429 | 0.107−1.729 | 0.234 | |||
Liver cirrhosis | 1.797 | 1.107−2.917 | 0.018 | |||
CAD | 0.405 | 0.252−0.651 | <0.001 | |||
Heart failure | 1.140 | 0.505−2.577 | 0.752 | |||
ESRD | 0.578 | 0.330−1.015 | 0.057 | |||
Thyroid dysfunction | 0.976 | 0.651−1.465 | 0.908 | |||
Procedure related | 0.445 | 0.235−0.841 | 0.013 | |||
Malignancy | 4.055 | 2.879−5.712 | <0.001 | 2.084 | 1.246–3.488 | 0.005 |
Lung CA | 2.348 | 1.769−3.117 | <0.001 | |||
Breast CA | 1.250 | 0.726−2.152 | 0.421 | |||
GI tract CA and HCC | 1.818 | 1.166−2.832 | 0.008 | |||
Leukemia and lymphoma | 0.917 | 0.407−2.066 | 0.834 | |||
NPC | 2.490 | 1.685−3.680 | <0.001 | 1.801 | 1.194–2.717 | 0.005 |
Metastasis | 3.565 | 2.651−4.794 | <0.001 | 2.088 | 1.352–3.223 | 0.001 |
Recurrence | 1.593 | 1.047−2.423 | 0.030 | |||
Prior history of pericardiocentesis | 1.388 | 0.865−2.227 | 0.174 | |||
WBC of PE (1000/μL) | 1.000 | 0.997−1.002 | 0.572 | |||
LDH of PE (mg/dL) | 1.000 | 0.998−1.003 | 0.865 | |||
Glucose of PE (mg/dL) | 1.001 | 1.000−1.001 | 0.206 | |||
Malignant cells in PE | 2.184 | 1.606−2.969 | <0.001 | |||
Dyspnea | 1.484 | 1.076−2.045 | 0.016 | |||
Tachycardia | 2.029 | 1.313−3.135 | 0.001 | |||
Shock | 0.952 | 0.713−1.271 | 0.739 | |||
Pleural effusion | 2.223 | 1.548−3.192 | <0.001 | |||
Ascites | 0.984 | 0.660−1.468 | 0.937 | |||
Cardiac tamponade | 1.397 | 0.931−2.098 | 0.106 | |||
Drainage amount | 1.000 | 0.999−1.000 | 0.287 | |||
Complications of pericardiocentesis | 0.049 | 0−19.601 | 0.324 |
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Shih, C.-T.; Lee, W.-C.; Fang, H.-Y.; Wu, P.-J.; Fang, Y.-N.; Chong, S.-Z. Outcomes of Patients with and without Malignancy Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion. J. Cardiovasc. Dev. Dis. 2021, 8, 150. https://doi.org/10.3390/jcdd8110150
Shih C-T, Lee W-C, Fang H-Y, Wu P-J, Fang Y-N, Chong S-Z. Outcomes of Patients with and without Malignancy Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion. Journal of Cardiovascular Development and Disease. 2021; 8(11):150. https://doi.org/10.3390/jcdd8110150
Chicago/Turabian StyleShih, Chun-Ting, Wei-Chieh Lee, Hsiu-Yu Fang, Po-Jui Wu, Yen-Nan Fang, and Shaur-Zheng Chong. 2021. "Outcomes of Patients with and without Malignancy Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion" Journal of Cardiovascular Development and Disease 8, no. 11: 150. https://doi.org/10.3390/jcdd8110150
APA StyleShih, C. -T., Lee, W. -C., Fang, H. -Y., Wu, P. -J., Fang, Y. -N., & Chong, S. -Z. (2021). Outcomes of Patients with and without Malignancy Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion. Journal of Cardiovascular Development and Disease, 8(11), 150. https://doi.org/10.3390/jcdd8110150