Retrospective evaluation of etiologic causes and pleural culture results in patients with pleural effusion

Abstract

Aim: Pleural effusion may develop as a complication of many different diseases. In this study, we aimed to evaluate the causes of effusion, characteristics, and pleural fluid cultures of patients who were hospitalized with pleural effusion or who were found to have pleural effusion during investigations. Materials and Methods: In the study, patients over the age of 18 who were hospitalized between April 2020 and June 2022 and who were diagnosed with pleural effusion and underwent thoracentesis were retrospectively evaluated. The study included 84 patients. The findings of the patients were obtained from consultation notes and the hospital automation system. The location of pleural fluid was recorded as unilateral (right or left) or bilateral. The appearance of the pleural fluid (serous, hemorrhagic and purulent), biochemical analyses and pleural fluid cultures were analyzed. Light criteria were used for exudate-transudate differentiation of pleural effusion. Results: The mean age of the patients was 64.3±16.9 years and 48 (57.1%) were male. 52 (61.9%) patients had right pleural effusion, 19 (22.6%) had left pleural effusion and 13 (15.4%) had bilateral pleural effusion. Pleural fluid was most commonly serous in 59 (70.2%) patients, hemorrhagic in 14 (16.7%) patients, and purulent in 11 (13.1%) patients. Exudate was found in 58 (69%) patients and transudate in 26 (30.9%) patients. Malignant pleural effusion was detected in 16 patients (19%). The mean age of patients with malignant pleural effusion was 70.1±11 years, which was higher than the general average. Of the 26 patients with transudates, 18 (69.2%) were male. Of those with exudates, 30 (51.7%) were male. Conclusion: The most common causes of pleural effusion were heart failure, malignant diseases, parapneumonic effusion, and empyema. Pleural fluid examinations from these patients are useful in terms of guiding the treatment.

Keywords

• empyema
• pleural effusion
• pleural fluid

Plevral efüzyonlu hastalarda etiyolojik nedenler ve plevral kültür sonuçlarının retrospektif değerlendirilmesi

Abstract

Amaç: Plevral efüzyon, birçok farklı hastalığın komplikasyonu olarak gelişebilir. Bu çalışmada, hastanemize plevral efüzyon nedeni ile yatırılan veya incelemeler sırasında plevral efüzyon saptanan hastaların efüzyon nedenlerinin, özelliklerinin ve plevral sıvı kültürlerinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Çalışmada Nisan 2020-Haziran 2022 tarihleri arasında hastanede yatan plevral efüzyon saptanan ve torasentez işlemi uygulanan 18 yaşın üzerindeki hastalar retrospektif olarak değerlendirildi. Çalışmaya 84 hasta dahil edildi. Hastalara ait bulgular konsültasyon notları ve hastane otomasyon sisteminden elde edildi. Plevral sıvının yerleşimi unilateral (sağ veya sol) veya bilateral olarak kaydedildi. Plevral sıvının görünümü (seröz, hemorajik ve püy), biyokimyasal analizler ve plevra sıvısı kültürleri incelendi. Plevral efüzyonun eksüda-transüda ayrımı için Light kriterleri kullanıldı. Bulgular: Hastaların yaş ortalaması 64,3±16,9 yıl ve 48'i (%57,1) erkek cinsiyette idi. 52(%61,9) hastada sağda, 19 (%22,6) hastada solda, 13 (%15,4) hastada bilateral plevral efüzyon saptandı. Plevral sıvı, en sık olarak 59 (%70,2) hastada seröz görünümde, 14 (%16,7) hastada hemorajik, 11 (%13,1) hastada pürülan görünümündeydi. 58 (%69) hastada eksüda, 26 (%30,9) hastada transüda saptandı. Olguların 16’sında (%19) malign plevral efüzyon saptandı. Malign plevral efüzyonu olanların yaş ortalaması 70,1±10,11 yıl olup, genel ortalamadan daha yüksekti. Transüdası olan 26 hastanın 18’i (%69,2) erkek cinsiyette idi. Eksüdası olanların ise 30’u (%51,7) erkek cinsiyette idi. Sonuç: Plevral efüzyonun en sık nedenleri olarak sırasıyla kalp yetmezliği, malign hastalıklar, parapnömonik efüzyon ve ampiyem olarak tespit edildi. Bu hastalardan alınan plevral sıvı incelemeleri tedaviye yol göstermesi açısından faydalıdır.

Keywords

• ampiyem
• plevral efüzyon
• plevral sıvı

References

1. Light RW. Pleural effusions. Med Clin North Am. 2011;95(6):1055-1070.
2. Beaudoin S, Gonzalez AV. Evaluation of the patient with pleural effusion. CMAJ. 2018;190(10):E291-E295.
3. Yan G, Li H, Bhetuwal A, McClure MA, Li Y, Yang G, et al. Pleural effusion volume in patients with acute pancreatitis: a retrospective study from three acute pancreatitis centers. Ann Med. 2021;53(1):2003-2018.
4. Chopra A, Highland KB, Kilb E, Huggins JT. The Relationship of Pleural and Pericardial Effusion With Pulmonary Hemodynamics in Patients With Pulmonary Hypertension. Am J Med Sci. 2021;361(6):731-735.
5. Hung TH, Tseng CW, Tsai CC, Tsai CC, Tseng KC, Hsieh YH. The long-term outcomes of cirrhotic patients with pleural effusion. Saudi J Gastroenterol. 2018;24(1):46-51.
6. Ferreiro L, San José ME, Valdés L. Management of Parapneumonic Pleural Effusion in Adults. Arch Bronconeumol. 2015;51(12):637-646.
7. Sahn SA. Diagnosis and management of parapneumonic effusions and empyema. Clin Infect Dis. 2007;45(11):1480-1486.
8. Li ST, Tancredi DJ. Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine. Pediatrics. 2010;125(1):26-33.

9. Grijalva CG, Zhu Y, Nuorti JP, Griffin MR. Emergence of parapneumonic empyema in the USA. Thorax. 2011;66(8):663-668.
10. Chong WH, Saha BK, Conuel E, Chopra A. The incidence of pleural effusion in COVID-19 pneumonia: State-of-the-art review. Heart Lung. 2021;50(4):481-490.
11. Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults. Am Fam Physician. 2006;73(7):1211-1220.
12. Thomas R, Lee YC. Causes and management of common benign pleural effusions. Thorac Surg Clin. 2013;23(1):25-42.
13. Kinasewitz GT. Transudative effusions. Eur Respir J. 1997;10(3):714-718.
14. Valdés L, Alvarez D, Valle JM, Pose A, San José E. The etiology of pleural effusions in an area with high incidence of tuberculosis. Chest. 1996;109(1):158-162.
15. Porcel JM, Esquerda A, Vives M, Bielsa S. Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses. Arch Bronconeumol. 2014;50(5):161-165.
16. Vázquez F, Michelángelo H, Trevisani H, González F, de Quiros B. Criterios diagnósticos para diferenciar trasudados de exudados en líquido pleural [Differential diagnosis between exudate and transudate in pleural effusion]. Medicina (B Aires). 1996;56(3):223-230.
17. Tokgöz F, Gökşenoğlu N, Bodur Y, Aksoy E, Aktaş O, Sevim T. Plevral efüzyonlu 240 olgunun retrospektif analizi. Eurasian J Pulmonol. 2014;16 78-83.
18. McCauley L, Dean N. Pneumonia and empyema: causal, casual or unknown. J Thorac Dis. 2015;7(6):992-998.
19. Ferreiro L, Porcel JM, Bielsa S, Toubes ME, Álvarez-Dobaño JM, Valdés L. Management of pleural infections. Expert Rev Respir Med. 2018;12(6):521-535.
20. Al-Tawfiq JA, Kim H, Memish ZA. Parasitic lung diseases. Eur Respir Rev. 2022;31(166):220093.
21. Erkoç MF, Öztoprak B, Alkan S, Okur A. A rare cause of pleural effusion: ruptured primary pleural hydatid cyst. BMJ Case Rep. 2014;2014:bcr2013202959.
22. Lal C, Huggins JT, Sahn SA. Parasitic diseases of the pleura. Am J Med Sci. 2013;345(5):385-389.
23. Sharma M, Gupta KB, Goyal KM, Nand N. Evaluation of cholinesterase to differentiate pleural exudates and transudates. J Assoc Physicians India. 2004;52:387-390.
24. Porcel JM. Identifying transudates misclassified by Light's criteria. Curr Opin Pulm Med. 2013;19(4):362-367.
25. Light RW. Pleural diseases, 6th ed, Philadelphia: Lippincott Williams&Wilkins; 2013.
26. Porcel JM, Light RW. Pleural effusions. Dis Mon. 2013;59:29–57.