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Background <p>Indwelling pleural catheters (IPCs) are commonly used to manage malignant pleural effusion (MPE), but spontaneous pleurodesis may allow for early catheter removal. This study investigates the rate, predictors, and timing of pleurodesis to enhance patient selection and optimize IPC management.</p> Methods <p>A 6-month prospective cohort study followed 50 patients with recurrent MPE who underwent IPC placement. Spontaneous pleurodesis was defined as catheter removal after sustained fluid cessation (&lt; 50&#xa0;mL/day for three consecutive drainages) without radiographic recurrence. Pleural fluid biochemistry, systemic inflammatory markers, and drainage patterns were analyzed. Kaplan–Meier curves were used to estimate the time to pleurodesis, and multivariable Cox regression identified independent predictors of success.</p> Results <p>Spontaneous pleurodesis occurred in 22 of 50 patients (44%), with a median time to pleurodesis of 42&#xa0;days (interquartile range (IQR) 30–60). Higher pleural fluid pH (&gt; 7.3, hazard ratio (HR 2.1), 95% confidence interval (CI) 1.4–3.2, <i>p</i> = 0.001) and protein levels (&gt; 3.0&#xa0;g/dL, HR 1.8, 95% CI 1.2–2.7, <i>p</i> = 0.003) were strong predictors of pleurodesis success. Patients with a progressive decline in daily fluid output, particularly those reaching &lt; 150&#xa0;mL/day by week 3, exhibited the highest pleurodesis rates (HR 3.5, 95% CI 2.1–5.8, <i>p</i> &lt; 0.001). A lower neutrophil-to-lymphocyte ratio (NLR) (&lt; 4.0) was also independently associated with successful pleurodesis (HR 1.6, 95% CI 1.0–2.5, <i>p</i> = 0.04), while cancer type and baseline C-reactive protein (CRP) levels showed no significant correlation.</p> Conclusion <p>Spontaneous pleurodesis occurs in nearly half of IPC patients, with higher pleural fluid pH, protein levels, and reduced drainage volume serving as key predictors. A lower NLR may further help in stratifying patients’ likelihood of pleurodesis success.</p> Graphical Abstract <p></p>

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Incidence and predictors of spontaneous pleurodesis in patients with indwelling pleural catheters: a prospective cohort study

  • 期刊论文

  • 发表日期：

    2025年10月24日

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  • Olivia Thompson,
  • James Carter,
  • Sophia Matthews,
  • Isabella Williams,
  • Zeyad Khalil,
  • Lucas Dowson

摘要

Background

Indwelling pleural catheters (IPCs) are commonly used to manage malignant pleural effusion (MPE), but spontaneous pleurodesis may allow for early catheter removal. This study investigates the rate, predictors, and timing of pleurodesis to enhance patient selection and optimize IPC management.

Methods

A 6-month prospective cohort study followed 50 patients with recurrent MPE who underwent IPC placement. Spontaneous pleurodesis was defined as catheter removal after sustained fluid cessation (< 50 mL/day for three consecutive drainages) without radiographic recurrence. Pleural fluid biochemistry, systemic inflammatory markers, and drainage patterns were analyzed. Kaplan–Meier curves were used to estimate the time to pleurodesis, and multivariable Cox regression identified independent predictors of success.

Results

Spontaneous pleurodesis occurred in 22 of 50 patients (44%), with a median time to pleurodesis of 42 days (interquartile range (IQR) 30–60). Higher pleural fluid pH (> 7.3, hazard ratio (HR 2.1), 95% confidence interval (CI) 1.4–3.2, p = 0.001) and protein levels (> 3.0 g/dL, HR 1.8, 95% CI 1.2–2.7, p = 0.003) were strong predictors of pleurodesis success. Patients with a progressive decline in daily fluid output, particularly those reaching < 150 mL/day by week 3, exhibited the highest pleurodesis rates (HR 3.5, 95% CI 2.1–5.8, p < 0.001). A lower neutrophil-to-lymphocyte ratio (NLR) (< 4.0) was also independently associated with successful pleurodesis (HR 1.6, 95% CI 1.0–2.5, p = 0.04), while cancer type and baseline C-reactive protein (CRP) levels showed no significant correlation.

Conclusion

Spontaneous pleurodesis occurs in nearly half of IPC patients, with higher pleural fluid pH, protein levels, and reduced drainage volume serving as key predictors. A lower NLR may further help in stratifying patients’ likelihood of pleurodesis success.

Graphical Abstract