Clinical Factors Influencing Spontaneous Pleurodesis Success in Malignant Pleural Effusion in Patients With Indwelling Pleural Catheter

TL;DR

This study finds that higher albumin levels, active cancer treatment, and fewer comorbidities improve success rates of spontaneous pleurodesis in patients with malignant pleural effusion.

Contribution

The study identifies clinical predictors of successful spontaneous pleurodesis in patients with indwelling pleural catheters.

Findings

Higher serum albumin levels were associated with successful spontaneous pleurodesis.

Patients receiving active anti-cancer therapy had significantly higher pleurodesis success rates.

Comorbidities like congestive cardiac failure and renal failure were more common in unsuccessful cases.

Abstract

Background

Indwelling pleural catheters (IPCs) provide effective palliation for malignant pleural effusion (MPE) and may induce spontaneous pleurodesis (SP). However, risk factors causing transudative effusion, such as hypoalbuminemia, congestive cardiac failure (CCF), and renal failure (RF), may reduce pleurodesis success. Evidence on the impact of these comorbidities in MPE patients undergoing IPC placement remains limited.

Objective

To evaluate the impact of hypoalbuminemia, CCF and RF on successful SP in MPE.

Methods

A retrospective single-centre study was conducted in a tertiary care hospital on all patients with cytologically or radiologically confirmed MPE who underwent IPC placement between January 2020 and December 2024. SP was defined as catheter removal and no fluid recurrence up to 90 days. Demographic data, albumin levels, comorbidities, cancer type, and active anti-cancer therapy were compared between the SP and non-pleurodesis (NP) group.

Results

Among 110 patients (mean age 70 years; 54/110, 49% male), SP occurred in 30/110 (27%). Mean serum albumin was higher in the SP group (25.2 vs 20.4 g/L, p=0.001). CCF was present in 3/30 (10%) SP group compared with 15/80 (19%) NP group (p=0.005), while RF occurred only in the NP group, 4/80 (5%). Systemic anti-cancer therapy was associated with higher SP rates (26/30, 87% vs 32/80, 40%; p<0.001). SP varied by cancer type, highest in mesothelioma (6/12, 50%) and absent in small cell lung cancer (0/3, 0%).

Conclusions

Higher albumin, active anti-cancer therapy, and absence of multiple comorbidities causing transudative effusion predict successful SP. Identifying these factors may improve patient selection and procedural outcomes.

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