Pleural effusion in acute pulmonary embolism: characteristics and relevance
Introduction The characteristics and clinical relevance of pleural effusion (PLEF) in acute pulmonary embolism (APE) are not fully understood.Methods A single-centre, retrospective study was performed of patients admitted with APE classified according to the subsequent development or not of PLEF. A...
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BMJ Publishing Group
2024-11-01
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| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/11/1/e002179.full |
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| author | Nuria Rodríguez-Núñez Francisco Gude Lucía Ferreiro Elisa Landín-Rey María Carreiras-Cuiña Borja Otero María Cruz Carbajales Honorio J Martínez-Martínez Carla Díaz-Louzao Roi Soto-Feijoo Juan Suárez Antelo Maria E Toubes Luis Valdés-Cuadrado |
| author_facet | Nuria Rodríguez-Núñez Francisco Gude Lucía Ferreiro Elisa Landín-Rey María Carreiras-Cuiña Borja Otero María Cruz Carbajales Honorio J Martínez-Martínez Carla Díaz-Louzao Roi Soto-Feijoo Juan Suárez Antelo Maria E Toubes Luis Valdés-Cuadrado |
| author_sort | Nuria Rodríguez-Núñez |
| collection | DOAJ |
| description | Introduction The characteristics and clinical relevance of pleural effusion (PLEF) in acute pulmonary embolism (APE) are not fully understood.Methods A single-centre, retrospective study was performed of patients admitted with APE classified according to the subsequent development or not of PLEF. A model was built to predict PLEF and its impact on 30-day all-cause mortality was investigated.Results A total of 1602 patients with APE were included (median age, 74 (61, 82) years; 674 men (42.1%); 382 (23.8%) with PLEF). PLEF was associated with a higher number of comorbidities (p=0.015); more peripheral APE (0.001); a higher frequency of pulmonary infarctions (p<0.001) and higher 30-day all-cause mortality (p=0.004) compared with those without PLEF. Bilateral PLEFs, as compared with unilateral, were associated with a higher number of comorbidities (p=0.009); more severe (simplified Pulmonary Embolism Severity Index ≥1; p<0.001) and higher 30-day all-cause mortality (p<0.001).On multivariate analysis, the presence of PLEF was associated with atrial fibrillation (OR 2.00; 95% CI 1.32 to 3.02), congestive heart failure (OR 3.00; 95% CI 1.81 to 5.00), pulmonary infarction (OR 3.19; 95% CI 2.38 to 4.29) and a Charlson index ≥3 (OR 1.59; 95% CI 1.03 to 2.45). The predictive model for PLEF had a moderate power of discrimination (area under the curve, AUC 0.76; 95% CI 0.73 to 0.79), whereas the predictive model for mortality showed a good predictive power (AUC 0.89; 95% CI 0.86 to 0.93). The presence of PLEF doubles the probability of death (OR 2.02; 95% CI 1.11 to 3.68). When PLEF is bilateral, the probability of death is four times higher, as compared with unilateral PLEF (OR 4.07; 95% CI 1.53 to 10.85; AUC 0.90; 95% CI 0.84 to 0.95).Conclusions A significant number of APE patients develop PLEF. The model showed a good power of discrimination for the prediction of mortality. The probability of death from APE doubles in the presence of PLEF. Patients with APE and concomitant bilateral PLEF have a fourfold higher risk of mortality, as compared with patients with concomitant unilateral PLEF. |
| format | Article |
| id | doaj-art-8a18aa3d63fa43e5bfbf26cf5dcd20fb |
| institution | Kabale University |
| issn | 2052-4439 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj-art-8a18aa3d63fa43e5bfbf26cf5dcd20fb2024-11-14T12:50:09ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392024-11-0111110.1136/bmjresp-2023-002179Pleural effusion in acute pulmonary embolism: characteristics and relevanceNuria Rodríguez-Núñez0Francisco Gude1Lucía Ferreiro2Elisa Landín-Rey3María Carreiras-Cuiña4Borja Otero5María Cruz Carbajales6Honorio J Martínez-Martínez7Carla Díaz-Louzao8Roi Soto-Feijoo9Juan Suárez Antelo10Maria E Toubes11Luis Valdés-Cuadrado12Pneumology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, SpainConcepción Arenal Primary Care Center, Santiago de Compostela, SpainPneumology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, SpainPneumology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, SpainPneumology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, SpainESTEVE, Santiago de compostela, SpainESTEVE, Santiago de compostela, SpainPneumology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, SpainResearch Methods (RESMET), Health Research Institute of Santiago de Compostela, Santiago de Compostela, SpainPneumology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, SpainPneumology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, SpainPneumology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, SpainPneumology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, SpainIntroduction The characteristics and clinical relevance of pleural effusion (PLEF) in acute pulmonary embolism (APE) are not fully understood.Methods A single-centre, retrospective study was performed of patients admitted with APE classified according to the subsequent development or not of PLEF. A model was built to predict PLEF and its impact on 30-day all-cause mortality was investigated.Results A total of 1602 patients with APE were included (median age, 74 (61, 82) years; 674 men (42.1%); 382 (23.8%) with PLEF). PLEF was associated with a higher number of comorbidities (p=0.015); more peripheral APE (0.001); a higher frequency of pulmonary infarctions (p<0.001) and higher 30-day all-cause mortality (p=0.004) compared with those without PLEF. Bilateral PLEFs, as compared with unilateral, were associated with a higher number of comorbidities (p=0.009); more severe (simplified Pulmonary Embolism Severity Index ≥1; p<0.001) and higher 30-day all-cause mortality (p<0.001).On multivariate analysis, the presence of PLEF was associated with atrial fibrillation (OR 2.00; 95% CI 1.32 to 3.02), congestive heart failure (OR 3.00; 95% CI 1.81 to 5.00), pulmonary infarction (OR 3.19; 95% CI 2.38 to 4.29) and a Charlson index ≥3 (OR 1.59; 95% CI 1.03 to 2.45). The predictive model for PLEF had a moderate power of discrimination (area under the curve, AUC 0.76; 95% CI 0.73 to 0.79), whereas the predictive model for mortality showed a good predictive power (AUC 0.89; 95% CI 0.86 to 0.93). The presence of PLEF doubles the probability of death (OR 2.02; 95% CI 1.11 to 3.68). When PLEF is bilateral, the probability of death is four times higher, as compared with unilateral PLEF (OR 4.07; 95% CI 1.53 to 10.85; AUC 0.90; 95% CI 0.84 to 0.95).Conclusions A significant number of APE patients develop PLEF. The model showed a good power of discrimination for the prediction of mortality. The probability of death from APE doubles in the presence of PLEF. Patients with APE and concomitant bilateral PLEF have a fourfold higher risk of mortality, as compared with patients with concomitant unilateral PLEF.https://bmjopenrespres.bmj.com/content/11/1/e002179.full |
| spellingShingle | Nuria Rodríguez-Núñez Francisco Gude Lucía Ferreiro Elisa Landín-Rey María Carreiras-Cuiña Borja Otero María Cruz Carbajales Honorio J Martínez-Martínez Carla Díaz-Louzao Roi Soto-Feijoo Juan Suárez Antelo Maria E Toubes Luis Valdés-Cuadrado Pleural effusion in acute pulmonary embolism: characteristics and relevance BMJ Open Respiratory Research |
| title | Pleural effusion in acute pulmonary embolism: characteristics and relevance |
| title_full | Pleural effusion in acute pulmonary embolism: characteristics and relevance |
| title_fullStr | Pleural effusion in acute pulmonary embolism: characteristics and relevance |
| title_full_unstemmed | Pleural effusion in acute pulmonary embolism: characteristics and relevance |
| title_short | Pleural effusion in acute pulmonary embolism: characteristics and relevance |
| title_sort | pleural effusion in acute pulmonary embolism characteristics and relevance |
| url | https://bmjopenrespres.bmj.com/content/11/1/e002179.full |
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