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Mortality Following Catheter Drainage Versus Thoracentesis in Cirrhotic Patients with Pleural Effusion

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Abstract

Background

Pleural effusion is an abnormal collection of body fluids that may cause related morbidity or mortality in cirrhotic patients. There are insufficient data to determine the optimal method of drainage, for symptomatic relief in cirrhotic patients with pleural effusion.

Aims

In this study, we compare the mortality outcomes of catheter drainage versus thoracentesis in cirrhotic patients.

Methods

The National Health Insurance Database, derived from the Taiwan National Health Insurance Program, was used to identify cirrhotic patients with pleural effusion requiring drainage between January 1, 2007, and December 31, 2010. In all, 2556 cirrhotic patients with pleural effusion were selected for the study and divided into the two groups (n = 1278/group) after propensity score matching.

Results

The mean age was 61.0 ± 14.3 years, and 68.9% (1761/2556) were men. The overall 30-day mortality was 21.0% (538/2556) and was higher in patients treated with catheter drainage than those treated with thoracentesis (23.5 vs. 18.6%, respectively, P < 0.001 by log-rank test). After Cox proportional hazard regression analysis adjusted by patient sex, age, and comorbid disorders, the risk of 30-day mortality was significantly higher in cirrhotic patients who accepted catheter drainage compared to thoracentesis (hazard ratio 1.30, 95% confidence interval 1.10–1.54, P = 0.003). Old age, hepatic encephalopathy, bleeding esophageal varices, hepatocellular carcinoma, ascites, and pneumonia were associated with higher risks for 30-day mortality.

Conclusion

In cirrhotic patients with pleural effusion requiring drainage, catheter drainage is associated with higher mortality compared to thoracentesis.

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Abbreviations

CI:

Confidence interval

EVB:

Esophageal variceal bleeding

HCC:

Hepatocellular carcinoma

HE:

Hepatic encephalopathy

HR:

Hazard ratio

NHIB:

National Health Insurance Bureau

NHRI:

National Health Research Institute

RFI:

Renal functional impairment

SBP:

Spontaneous bacterial peritonitis

TIPS:

Transjugular intrahepatic portosystemic shunt

MELD:

Model for End-Stage Liver Disease

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Acknowledgments

This study was based, in part, on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, which is managed by National Health Research Institutes (Registered number: 101516). The interpretations and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or National Health Research Institutes.

Author's Contributions

T-HH provided material support, collected and analyzed the data, and drafted the manuscript. C-CT provided material support and contributed to the design of the study. C-WT contributed to the design of the study, provided material support, drafted the manuscript, and critically revised the manuscript for important intellectual content. K-CT provided material support and critically revised the manuscript for important intellectual content. Y-HH contributed to the design of the study and critically revised the manuscript for important intellectual content. C-CT analyzed the data.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County, 62247, Taiwan

    Tsung-Hsing Hung, Chih-Wei Tseng, Yu-Hsi Hsieh & Kuo-Chih Tseng

  2. School of Medicine, Tzu Chi University, Hualien, Taiwan

    Tsung-Hsing Hung, Chih-Wei Tseng, Chen-Chi Tsai, Yu-Hsi Hsieh & Kuo-Chih Tseng

  3. Department of Mathematics, Tamkang University, Tamsui, Taiwan

    Chih-Chun Tsai

  4. Division of Infectious Disease, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan

    Chen-Chi Tsai

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  1. Tsung-Hsing Hung
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  2. Chih-Wei Tseng
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  3. Chen-Chi Tsai
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  4. Yu-Hsi Hsieh
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  5. Kuo-Chih Tseng
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Correspondence to Chih-Wei Tseng.

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Hung, TH., Tseng, CW., Tsai, CC. et al. Mortality Following Catheter Drainage Versus Thoracentesis in Cirrhotic Patients with Pleural Effusion. Dig Dis Sci 62, 1080–1085 (2017). https://doi.org/10.1007/s10620-017-4463-8

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  • DOI: https://doi.org/10.1007/s10620-017-4463-8

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