Introduction and objectives Non-Malignant Pleural Effusions (NMPE) have an estimated annual incidence of 200,000 in the UK.¹ They are often secondary to underlying organ dysfunction, with congestive heart failure (CHF) the leading cause. CHF itself carries a high mortality risk, with 28% of patients with New York Heart Association(NYHA) class IV dying within a year.² Despite this, information on baseline characteristics, prognostic features and mortality in NMPE is sparse. Our aim is to determine the mortality rates in NMPEs in a prospective observational trial.

Methods We recruited 784 consecutive patients presenting to a pleural service, between 03/2008 and 03/2015, with an undiagnosed pleural effusion. Further analysis was conducted on the 355 patients with NMPE.

Pleural biochemistry, cytology, thoracic USS and chest radiograph were performed. Echocardiogram, CT scans, radiological-guided biopsy and medical thoracoscopy were undertaken as clinically indicated. Patients were followed-up for a minimum duration of 12 months with final diagnosis decided by independent review by 2 respiratory consultants. Survival data was calculated from study entry to death. Surviving patients were censored on 07/2016.

Results Of the 784 patients, 355 (45%) were diagnosed with a NMPE. These patients had a mean age of 68 (SD17) with 69% of patients male. Patients with CHF (HR 4.7 CI: 2.3–9.5) had a 50% 1-year mortality and a mean age of 79. Renal failure (HR 5.2 CI: 2.1–12.9) and liver failure (HR 4.8 CI: 1.9–11.8) patients had 1-year mortality rates of 31% and 25% respectively (HR c/w inflammatory pleuritis). Bilateral effusions (HR 2.6 CI 1.7–3.9) and transudative effusions (HR 3.1 CI: 2.2–4.3) were associated with a worse prognosis in patients with NMPE, with a 57% and 44% 1-year mortality respectively.

Conclusion This is the largest prospectively collected series in patients with NMPE, demonstrating that those secondary to organ dysfunction have an extremely high 1-year mortality. The presence of a pleural effusion in patients with CHF is a marker of severe disease, almost doubling the mortality risk compared to patients with NYHA class IV CHF.

References

1. Light RW. Pleural effusions. Medical Clinics of North America 2011;95(6): 1055–70.

2. Muntwyler J. One-year mortality among unselected outpatients with heart failure. EHJ 2002;23(23):1861–6.

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Abstract S92 Figure 1

Kaplan-meier survival curve according to disease type