Inflammatory parameters after pleurodesis in recurrent malignant pleural effusions and their predictive value.
Recurrent pleural malignant effusion is a common problem which can be treated by inducing symphysis of the pleural sheets. Many different drugs administered into the pleural space can be used to achieve this. The drugs cause an inflammatory response, which in turn is believed to cause the symphysis. Comparatively little has been published on the degree of pleural inflammation and the systemic response and whether this will affect the outcome. The aim of this study was to describe the systemic inflammatory reaction following instillation of a chemical agent into the pleura and to investigate whether this had any predictive value for the outcome (i.e. the pleurodesis). The markers investigated were simple ones: erythrocyte sedimentation rate, C-reactive protein, and leukocyte count from venous blood samples, and the fever reaction. Eighty-nine prospective patients with malignant pleural effusion who underwent pleurodesis with either talc (48 patients) or quinacrine (41 patients) were included in the study. Symphysis was achieved in 82 patients (92 per cent) and all had a prominent transitional elevation of the inflammatory parameters. The unsuccessful attempts caused negligible or very small elevations, but due to the small numbers only the degree of fever after 8 and 48 h showed a statistically significant difference. In conclusion, pleurodesis causes a systemic inflammation and there is a tendency to a correlation between the success of pleurodesis and the degree of inflammation. High fever and high inflammatory parameters including CRP are due to this inflammatory response and do not indicate infection.
Ukale
Valiant
V
Department of Medicine, Thoracic Clinics, Karolinska Sjukhuset, Stockholm S-171 76, Sweden. valiant.ukale@ks.se
Agrenius
Veronica
V
Widström
Olle
O
Hassan
Alinaghizadeh
A
Hillerdal
Gunnar
G
D000368:Aged; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005947:Glucose / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007249:Inflammation / Q000139:chemically induced / Q000378:metabolism*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000378:metabolism / Q000628:therapy*; D010998:Pleurisy / Q000139:chemically induced / Q000378:metabolism; D018700:Pleurodesis; D011379:Prognosis; D011446:Prospective Studies; D011796:Quinacrine / Q000008:administration & dosage; D013627:Talc / Q000008:administration & dosage; D016896:Treatment Outcome
D013627:Talc; D002097:C-Reactive Protein; D011796:Quinacrine; D005947:Glucose