S118 Incidence And Severity Of Chronic Thromboembolic Pulmonary Hypertension Following The Introduction Of A One-stop Clinic For Acute Pulmonary Embolism

Abstract

Background The incidence of malignant pleural effusions (MPE) is increasing and overall prognosis remains poor. In-dwelling pleural catheters (IPCs) relieve symptoms, but increase the risk of pleural infection. We reviewed survival times of cases of pleural infection in patients with IPCs for MPE from 6 UK centres. Methods Baseline data were collected for all IPC insertions from 1/1/05 to 31/1/14. Survival times were analysed by underlying tumour. Results were compared with national data, and with data from a cohort of 789 patients with MPE (the LENT cohort). LENT scores were used to calculate individual predicted life expectancy, which was compared with actual survival. Results Of 672 IPCs inserted across 6 centres during the study period, 25 patients (3.6%) experienced pleural infection. 19/25 were male,median age 69 (range 35-79). 12/25 had mesothelioma, 8/25 lung cancer, 3/25 breast cancer, 1/25 lymphoma and 1/25 thyroid cancer. 18/25 had a performance status of 0-1, and 19/25 received oncological treatment.Survival with MPE and pleural infection compared favourably with the LENT cohort (see figure 1). Median survival with mesothelioma and pleural infection was 753 days (95% confidence interval 446-1089) compared with 339 days in the LENT cohort (95% CI 267-442) and less than 365 days in nationally reported data. Patients with lung cancer and pleural infection also outlived their LENT counterparts; median survival of 138 days (95% CI 62-479) versus 74 days (95% CI 60-90). Patients with breast cancer had similar survival times (167 vs 192 days). LENT scores were calculated where possible. 9/13 (69%) outlived their predicted life expectancy. 16/25 (64%) developed infection within 90 days of IPC insertion. There was no difference in survival times between patients with early and late infection (p = 0.6). Discussion In this series of patients with IPCs, pleural infection was associated with longer survival with mesothelioma and lung cancer, but not breast cancer. Most patients experienced early infection, suggesting this result isn't simply a result of higher infection rates in patients who survive longer with an IPC in situ. We propose that pleural infection stimulates a local immune response, which acts against tumour. Further studies are planned to investigate this hypothesis further. Introduction The management and follow-up of pulmonary embolism (PE) is delivered by various specialities resulting in both under and over investigation for suspected chronic thromboembolic pulmonary hypertension (CTEPH). To standardise our approach to long-term PE management a "one-stop" clinic was established in Sheffield in March 2010 to review all patients approximately 3 months after their presentation with acute PE. The aim of this study was to evaluate the incidence and severity of CTEPH identified from a one-stop clinic using an investigative strategy based on careful clinical assessment Methods Consecutive patients attending the one-stop PE clinic following hospital admission with acute PE were identified. During the on...

Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature

“…In five other studies, echocardiography was only performed if dyspnoea was reported by the individual patients [7,17,30,31,46]. One study applied the need for further investigation based on a not-further-defined clinical assessment prior to RHC [22]. Three studies targeted patients with a first PE (595 patients in total) [17,44,50] and one study included 87 patients with recurrent VTE only [18].…”

“…The weighted pooled incidence of CTEPH in the all comers was 0.56% (95% CI 0.13-0.98; I 2 =98.3%). Four studies focused on unselected consecutive patients who were alive after an initial treatment period of at least 3 months [22,30,31,35]. The weighted pooled incidence of CTEPH in these 999 survivors followed for a period varying from 3 months to 8 years was 3.2% (95% CI 2.0-4.4; I 2 =7.0%).…”

Pulmonary Hypertension for the Non-Specialist

“…The incidence of CTEPH is acknowledged to be under-reported at 3-6 ppm per year with a prevalence of 26-38 ppm. [8][9][10] Globally, the causes of PH can differ signifi cantly, with cases of PH related to sickle cell disease and infectious diseases (HIV, schistosomiasis, post-Streptococcus rheumatic heart disease) more prevalent in countries where these are still endemic. 7 In the UK, the mean age at diagnosis of idiopathic pulmonary arterial hypertension (IPAH) is 60 years old, and 37.7% of IPAH patients are male.…”