Indwelling Tunneled Pleural Catheters for Refractory Hepatic Hydrothorax in Patients with Cirrhosis: A Multicenter Study.
Chest. 2018 Aug 29;:
Authors: Shojaee S, Rahman N, Haas K, Kern R, Leise M, Alnijoumi M, Lamb C, Majid A, Akulian J, Maldonado F, Lee H, Khalid M, Stravitz T, Kang L, Chen A
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 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 IPC and an underlying diagnosis of cirrhosis. Records were reviewed for patient demographics, operative reports and laboratory values. Kaplan-Meier method was used to estimate catheter time to removal. 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 (73%) and bridge to transplant in 21 (27%) patients. The median (range) in situ dwell time of all catheters was 156 (16-1978) days. Eight (10%) patients were found to have pleural space infection, five of whom also had catheter-site cellulitis. Two (2.5%) patients died secondary to catheter related sepsis. Catheter removal secondary to spontaneous pleurodesis was achieved in 22 (28%) patients. Median time from catheter insertion to pleurodesis was 55 (10-370) days. Older age was an independent predictor of mortality on multivariate analysis (Hazard ratio: 1.05, p=0.01).
CONCLUSIONS: We present, to our knowledge, the first multicenter study examining outcomes related to IPC 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 is associated with significant adverse events in this morbid population.
PMID: 30171863 [PubMed - as supplied by publisher]