Predictors of outcome of pleurodesis in patients with malignant pleural effusion: a systematic review and meta-analysis

ABSTRACT

Objectives

Pleurodesis is an important management option to palliate breathlessness in patients with malignant pleural effusion (MPE). This systematic review aimed to examine available literature for studies investigating factors that predict pleurodesis outcome.

Methods

The healthcare databases advanced search (HDAS) Medline and Embase in addition to Cochrane Database of Systematic Reviews were searched on for publications reporting on pleurodesis for MPE in English language. All study types reporting previously unpublished data on predictors of pleurodesis success were included. Thirty-four studies involving 4626 patients were included in the systematic review.

Results

The most common pleurodesis agent used was talc which was used in 27 studies. Meta-analyses demonstrated that the strongest predictors of pleurodesis success were higher pleural fluid pH, smaller volume of effusion pre-pleurodesis and full lung re-expansion post effusion drainage. Shorter duration of tube drainage, higher pleural fluid glucose, lower LDH, and lower pleural tumor burden all seem to favor pleurodesis success, but with considerable statistical heterogeneity between studies. Available data do not suggest that chest tube size affects pleurodesis outcome.

Conclusion

Overall, available results are difficult to interpret due to evidence quality. Prospective studies are needed to further explore these factors.

Protocol registration

CRD42018115874 (Prospero database of systematic reviews)

KEYWORDS:

• Pleural disease
• mesothelioma
• meta-analysis

Article Highlights

• Malignant pleural effusion is relatively common and often causes considerable breathlessness.

• Pleurodesis is one of the main management options for recurrent malignant pleural effusion.

• Studies report success rates of pleurodesis in malignant pleural effusion ranging between 60% and 90%.

• Strong predictors of pleurodesis success include higher pleural fluid pH, smaller volume of effusion pre-pleurodesis and full lung re-expansion post effusion drainage.

• Other potential predictors of pleurodesis success may include shorter duration of tube drainage, higher pleural fluid glucose, and lower pleural fluid LDH but the evidence base is less strong.

Declaration of interest

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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

MH conceived the study. MH and NMR wrote the protocol. EH performed the literature search. MH and MG screened the search results for eligibility and extracted the data. MH performed the statistics and drafted the first manuscript. NMR and RM critically revised the manuscript. All authors reviewed and approved the final manuscript.

Additional information

Funding

This paper was not funded.