What's the Score? Do Pleural Effusion Clinical Scoring Systems Help in Management of Disease?

Peter Grendelmeier; Najib M. Rahman

doi:10.1055/s-0039-1695058

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2019; 40(03): 394-401
DOI: 10.1055/s-0039-1695058

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

What's the Score? Do Pleural Effusion Clinical Scoring Systems Help in Management of Disease?

Peter Grendelmeier

¹Oxford Respiratory Trials Unit, Oxford Centre for Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Churchill Hospital Site, Oxford, England, United Kingdom

,

Najib M. Rahman

¹Oxford Respiratory Trials Unit, Oxford Centre for Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Churchill Hospital Site, Oxford, England, United Kingdom

› Author Affiliations

Abstract

Pleural effusion is a common condition, affecting over 3,000 people per million population every year. More than 50 causes of pleural effusions are known, including pleural infection and malignant pleural disease. These conditions place a large burden on healthcare systems with one-fourth of patients with pleural infection having a length of hospital stay of more than 1 month. Malignant pleural effusion represents advanced malignant disease with a correspondingly high mortality. Prognostic models using clinical information in combination with blood or pleural fluid biomarkers predicting survival and other outcome measures are therefore a priority in improving clinical care, and potentially outcomes. Identifying patients with poor prognosis may help avoid discomfort and unnecessary interventions at the end of their lives, while, on the other hand, individuals with scores predicting a particularly good prognosis might be selected for more aggressive early treatment. Such scores must be based on data representing routine practice in a general hospital and variables chosen based on their clinical availability at clinical decision points (i.e., before treatment is instituted), making the findings widely applicable.

Keywords

pleural effusion - scores - prognosis - management - pleural infection - malignant disease - LENT - PROMISE

Full Text

References

References
1 Mercer RM, Psallidas I, Rahman NM. Ultrasound in the management of pleural disease. Expert Rev Respir Med 2017; 11 (04) 323-331
2 Bhatnagar R, Maskell N. The modern diagnosis and management of pleural effusions. BMJ 2015; 351: h4520
3 Taghizadeh N, Fortin M, Tremblay A. US hospitalizations for malignant pleural effusions: data from the 2012 National Inpatient Sample. Chest 2017; 151 (04) 845-854
4 Rahman NM, Kahan BC, Miller RF, Gleeson FV, Nunn AJ, Maskell NA. A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection. Chest 2014; 145 (04) 848-855
5 Psallidas I, Kanellakis NI, Gerry S. , et al. Development and validation of response markers to predict survival and pleurodesis success in patients with malignant pleural effusion (PROMISE): a multicohort analysis. Lancet Oncol 2018; 19 (07) 930-939
6 Clive AO, Kahan BC, Hooper CE. , et al. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax 2014; 69 (12) 1098-1104
7 Psallidas I, Yousuf A, Talwar A. , et al. Assessment of patient-reported outcome measures in pleural interventions. BMJ Open Respir Res 2017; 4 (01) e000171
8 Mishra EK, Clive AO, Wills GH. , et al. Randomized controlled trial of urokinase versus placebo for nondraining malignant pleural effusion. Am J Respir Crit Care Med 2018; 197 (04) 502-508
9 Llamas-Álvarez AM, Tenza-Lozano EM, Latour-Pérez J. Diaphragm and lung ultrasound to predict weaning outcome: systematic review and meta-analysis. Chest 2017; 152 (06) 1140-1150
10 Wang JS, Tseng CH. Changes in pulmonary mechanics and gas exchange after thoracentesis on patients with inversion of a hemidiaphragm secondary to large pleural effusion. Chest 1995; 107 (06) 1610-1614
11 Wang LM, Cherng JM, Wang JS. Improved lung function after thoracocentesis in patients with paradoxical movement of a hemidiaphragm secondary to a large pleural effusion. Respirology 2007; 12 (05) 719-723
12 Salamonsen MR, Lo AKC, Ng ACT, Bashirzadeh F, Wang WYS, Fielding DIK. Novel use of pleural ultrasound can identify malignant entrapped lung prior to effusion drainage. Chest 2014; 146 (05) 1286-1293
13 American Thoracic Society. Management of malignant pleural effusions. Am J Respir Crit Care Med 2000; 162 (05) 1987-2001
14 Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ. ; BTS Pleural Disease Guideline Group. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65 (Suppl. 02) ii32-ii40
15 Davies HE, Lee YC. Management of malignant pleural effusions: questions that need answers. Curr Opin Pulm Med 2013; 19 (04) 374-379
16 Psallidas I, Kalomenidis I, Porcel JM, Robinson BW, Stathopoulos GT. Malignant pleural effusion: from bench to bedside. Eur Respir Rev 2016; 25 (140) 189-198
17 Rahman NM, Pepperell J, Rehal S. , et al. Effect of opioids vs NSAIDs and larger vs smaller chest tube size on pain control and pleurodesis efficacy among patients with malignant pleural effusion: the TIME1 randomized clinical trial. JAMA 2015; 314 (24) 2641-2653
18 Pilling JE, Dusmet ME, Ladas G, Goldstraw P. Prognostic factors for survival after surgical palliation of malignant pleural effusion. J Thorac Oncol 2010; 5 (10) 1544-1550
19 Bielsa S, Salud A, Martínez M. , et al. Prognostic significance of pleural fluid data in patients with malignant effusion. Eur J Intern Med 2008; 19 (05) 334-339
20 Ozyurtkan MO, Balci AE, Cakmak M. Predictors of mortality within three months in the patients with malignant pleural effusion. Eur J Intern Med 2010; 21 (01) 30-34
21 Burrows CM, Mathews WC, Colt HG. Predicting survival in patients with recurrent symptomatic malignant pleural effusions: an assessment of the prognostic values of physiologic, morphologic, and quality of life measures of extent of disease. Chest 2000; 117 (01) 73-78
22 Proctor MJ, Morrison DS, Talwar D. , et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer 2011; 47 (17) 2633-2641
23 Kao SC, Pavlakis N, Harvie R. , et al. High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res 2010; 16 (23) 5805-5813
24 Pinato DJ, Mauri FA, Ramakrishnan R, Wahab L, Lloyd T, Sharma R. Inflammation-based prognostic indices in malignant pleural mesothelioma. J Thorac Oncol 2012; 7 (03) 587-594
25 Davies HE, Mishra EK, Kahan BC. , et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA 2012; 307 (22) 2383-2389
26 Psallidas I, Piotrowska HEG, Yousuf A. , et al. Efficacy of sonographic and biological pleurodesis indicators of malignant pleural effusion (SIMPLE): protocol of a randomised controlled trial. BMJ Open Respir Res 2017; 4 (01) e000225
27 Tan C, Sedrakyan A, Browne J, Swift S, Treasure T. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. Eur J Cardiothorac Surg 2006; 29 (05) 829-838
28 Feller-Kopman DJ, Reddy CB, DeCamp MM. , et al. Management of malignant pleural effusions. An official ATS/STS/STR clinical practice guideline. Am J Respir Crit Care Med 2018; 198 (07) 839-849
29 Clive AO, Jones HE, Bhatnagar R, Preston NJ, Maskell N. Interventions for the management of malignant pleural effusions: a network meta-analysis. Cochrane Database Syst Rev 2016; (05) CD010529
30 Corcoran JP, Hallifax RJ, Mercer RM. , et al. Thoracic Ultrasound as an Early Predictor of Pleurodesis Success in Malignant Pleural Effusion. Chest 2018; 154 (05) 1115-1120
31 Zhu Z, Donnelly E, Dikensoy O. , et al. Efficacy of ultrasound in the diagnosis of pleurodesis in rabbits. Chest 2005; 128 (02) 934-939
32 The efficacy of sonographic and biological pleurodesis indicators of malignant pleural effusion (SIMPLE). Available at: https://doi.org/10.1186/ISRCTN16441661 . Accessed July 31, 2019
33 Light RW, Girard WM, Jenkinson SG, George RB. Parapneumonic effusions. Am J Med 1980; 69 (04) 507-512
34 Maskell NA, Davies CWH, Nunn AJ. , et al; First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005; 352 (09) 865-874
35 Finley C, Clifton J, Fitzgerald JM, Yee J. Empyema: an increasing concern in Canada. Can Respir J 2008; 15 (02) 85-89
36 Farjah F, Symons RG, Krishnadasan B, Wood DE, Flum DR. Management of pleural space infections: a population-based analysis. J Thorac Cardiovasc Surg 2007; 133 (02) 346-351
37 Davies CW, Kearney SE, Gleeson FV, Davies RJ. Predictors of outcome and long-term survival in patients with pleural infection. Am J Respir Crit Care Med 1999; 160 (5, Pt 1): 1682-1687
38 Rahman NM, Maskell NA, West A. , et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med 2011; 365 (06) 518-526
39 Corcoran JP, Wrightson JM, Belcher E, DeCamp MM, Feller-Kopman D, Rahman NM. Pleural infection: past, present, and future directions. Lancet Respir Med 2015; 3 (07) 563-577
40 Podbielski FJ, Maniar HS, Rodriguez HE, Hernan MJ, Vigneswaran WT. Surgical strategy of complex empyema thoracis. JSLS 2000; 4 (04) 287-290
41 Cunniffe MG, Maguire D, McAnena OJ, Johnston S, Gilmartin JJ. Video-assisted thoracoscopic surgery in the management of loculated empyema. Surg Endosc 2000; 14 (02) 175-178
42 Waller DA, Rengarajan A, Nicholson FH, Rajesh PB. Delayed referral reduces the success of video-assisted thoracoscopic debridement for post-pneumonic empyema. Respir Med 2001; 95 (10) 836-840
43 Allen MS, Deschamps C, Jones DM, Trastek VF, Pairolero PC. Video-assisted thoracic surgical procedures: the Mayo experience. Mayo Clin Proc 1996; 71 (04) 351-359
44 Perttunen K, Tasmuth T, Kalso E. Chronic pain after thoracic surgery: a follow-up study. Acta Anaesthesiol Scand 1999; 43 (05) 563-567
45 Jiménez Castro D, Díaz G, Pérez-Rodríguez E, Light RW. Prognostic features of residual pleural thickening in parapneumonic pleural effusions. Eur Respir J 2003; 21 (06) 952-955
46 The Pleural Infection Longitudinal Outcome Study. Available at: https://doi.org/10.1186/ISRCTN50236700 . Accessed July 31, 2019
47 Porcel JM. Pleural effusions from congestive heart failure. Semin Respir Crit Care Med 2010; 31 (06) 689-697
48 Porcel JM, Ferreiro L, Civit C. , et al. Development and validation of a scoring system for the identification of pleural exudates of cardiac origin. Eur J Intern Med 2018; 50: 60-64
49 Light RW, Macgregor MI, Luchsinger PC, Ball Jr WC. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972; 77 (04) 507-513
50 Bielsa S, Porcel JM, Castellote J, Mas E, Esquerda A, Light RW. Solving the Light's criteria misclassification rate of cardiac and hepatic transudates. Respirology 2012; 17 (04) 721-726
51 Porcel JM, Chorda J, Cao G, Esquerda A, Ruiz-González A, Vives M. Comparing serum and pleural fluid pro-brain natriuretic peptide (NT-proBNP) levels with pleural-to-serum albumin gradient for the identification of cardiac effusions misclassified by Light's criteria. Respirology 2007; 12 (05) 654-659
52 Romero-Candeira S, Hernández L, Romero-Brufao S, Orts D, Fernández C, Martín C. Is it meaningful to use biochemical parameters to discriminate between transudative and exudative pleural effusions?. Chest 2002; 122 (05) 1524-1529
53 Porcel JM, Vives M, Cao G, Esquerda A, Rubio M, Rivas MC. Measurement of pro-brain natriuretic peptide in pleural fluid for the diagnosis of pleural effusions due to heart failure. Am J Med 2004; 116 (06) 417-420
54 Porcel JM, Martínez-Alonso M, Cao G, Bielsa S, Sopena A, Esquerda A. Biomarkers of heart failure in pleural fluid. Chest 2009; 136 (03) 671-677