Effects of Coexisting Pneumonia and End-stage Renal Disease on Pleural Fluid Analysis in Patients With Hydrostatic Pleural Effusion

Abstract

Background: In individual patients, especially those who are hospitalized, several conditions often coexist that may be responsible for the development of a pleural effusion and may affect the pleural fl uid analysis (PFA). The objective of this study was to investigate the effects of end-stage renal disease and pneumonia on PFA in patients with hydrostatic pleural effusion. Methods:In a retrospective analysis of 1,064 consecutive patients who underwent thoracentesis at a university hospital, cell counts and pleural fl uid protein, lactate dehydrogenase, pH, and glucose levels were examined in those (n 5 300) with clinical evidence of hydrostatic pleural effusion. Results: The 300 patients (28.1%) with pleural effusions had congestive heart failure (CHF), circulatory overload (CO), or both. Expert consensus was achieved in 66 (22%) for CHF as the sole diagnosis (SCHF), 30 (10%) for CHF and coexisting pneumonia (PCHF), and 26 (8.7%) for end-stage renal disease (ESRD) with coexisting CO or CHF. The remaining 178 patients were excluded because of complicating conditions. There were minor, but statistically signifi cant differences in pleural fl uid/serum protein ratios in patients with ESRD with coexisting CO or CHF compared with SCHF. Compared with SCHF, there were statistically signifi cant tendencies for higher protein and lactate dehydrogenase concentrations and lower pH levels in those with PCHF. The total nucleated cell count and the absolute neutrophil count were signifi cantly higher in PCHF. Conclusions: ESRD in patients with hydrostatic pleural effusions has a minimal effect on the PFA. Coexisting pneumonia most often results in an exudative effusion in patients with CHF.CHEST 2013; 143(6):1709-1716Abbreviations: ANC 5 absolute neutrophil count; CHF 5 congestive heart failure; CO 5 circulatory overload; ESRD 5 endstage renal disease; ESRDCOCHF 5 end-stage renal disease with coexisting circulatory overload or congestive heart failure; LDH 5 lactate dehydrogenase; PCHF 5 congestive heart failure and coexisting pneumonia; PFA 5 pleural fl uid analysis; SCHF 5 congestive heart failure as the sole diagnosis; TNC 5 total nucleated cell count

Pleural effusion portends a poor prognosis in patients on continuous ambulatory peritoneal dialysis

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Clinical characteristics and prognostic factors of non-malignant pleural effusions in hospitalised patients: a retrospective cohort study

“…One retrospective study reported that in patients with chronic heart failure and concomitant pneumonia, 8 of 30 effusions remained transudate according to Light’s criteria. 15 In this study, pneumonia was diagnosed based on the presence of systemic inflammation syndrome and respiratory symptoms, and patients with other complicated conditions were excluded. In our study, pneumonia was determined based on the patient’s admission diagnosis and image findings, which may explain the lower proportion of exudates in our study.…”