Empirical anti-tuberculous therapy for the massive pericardial effusion of unknown etiology

Abstract

Objective

The aim of this study was to evaluate the efficacy and safety of empirical anti-tuberculous therapy (ATT) in patients with massive pericardial effusion (MPE) of unknown etiology in China.

Methods

In-hospital patients with MPE were assessed retrospectively. Based on thorough examination excluding neoplastic, autoimmune, and non-tuberculous infectious diseases, patients who had no evidence of tuberculosis (TB) were treated with empirical ATT (Group A) or not treated with empirical ATT (Group C), whereas those who had evidence of TB were treated with standard ATT (Group B). Clinical outcomes and mitigation of MPE were compared among the three groups to identify the effectiveness of ATT. The survival free of composite endpoint was estimated using the Kaplan-Meier method.

Results

A total of 185 eligible patients were recruited: 77 in Group A, 80 in Group B, and 28 in Group C. The average follow-up was 52.9 ± 30.7, 49.4 ± 29.7, and 51.8 ± 30.2 months for Groups A, B, and C, respectively. The incidence of composite endpoint was 23.3, 24.4, and 85.7% in Groups A, B, and C, respectively (p < .0001). However, the clinical recovery rate was greater in Group B compared with Group A (p = .027). No significant difference in the safety profile of ATT was noted between Groups A and B. MPE did not spontaneously decrease in 85.7% of patients in Group C.

Conclusions

Empirical ATT should be considered in MPE of unknown etiology in countries with a high burden of TB.

Keywords:

• Tuberculosis
• pericarditis
• pericardial effusion
• empirical anti-tuberculous therapy
• retrospective study

Transparency

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

CYW as the first author participated in the design of the study, the collection of the data, performed the statistical analysis, and drafted the manuscript. ATC contributed to the statistical check. XWY contributed to the design of the study and the revise of the manuscript for important intellectual content. XWY and SYZ provided final approval of the version to be published. All the other authors were involved in collecting the data and revised the manuscript. All authors have read and approved this manuscript.

Acknowledgements

The authors thank with grateful appreciation Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College for their assistance and financial support.

Additional information

Funding

This study was self-funded by Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College.