A longitudinal study of idiopathic exudative lymphocytic pleural effusion in older people.
OBJECTIVE
To assess the long-term prognosis of older patients with idiopathic exudative lymphocytic pleural effusion.


METHODS
Prospective observational study.


METHODS
A university-affiliated tertiary care center.


METHODS
Forty-seven consecutive patients (aged 74.9+/-5.4) with idiopathic exudative lymphocytic pleural effusion were enrolled over a 42-month period.


METHODS
Baseline sociodemographic information, clinical data, and Charlson Comorbidity Index score were obtained. After an exhaustive examination, clinical evaluation and periodic chest radiographs were taken until one of the endpoints was met: complete resolution of the pleural effusion, death from all causes, or the end of the study period.


RESULTS
The mean follow-up period was 16.3+/-17.0 months. During the course of the study, complete resolution of the pleural effusion occurred in 17% of the patients, whereas it remained stable in 45%, and progressed in 38%. In seven cases, the cause of the effusion was established after an average of 84 days, and in another two, the diagnosis was made postmortem. Malignancy was documented in eight of the nine cases. Although the burden of comorbidities and cardiac function at baseline were similar in the three categories, the 3-year survival rate was 63%, 5%, and 0%, respectively. None of the patients developed active tuberculosis, although 15% had positive tuberculin test.


CONCLUSIONS
By categorizing the presence of idiopathic effusion into resolving, persistent, or progressive, this study may provide a more practical approach to the long-term prognosis of older patients with idiopathic exudative lymphocytic effusion who refuse or are considered too frail to undergo an invasive procedure.
El Solh
Ali A
AA
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York 14215, USA. solh@buffalo.edu
Abdo
Toufic
T
Pineda
Lilibeth
L
Ramadan
Fadi
F
Berbary
Eileen
E
D000243:Adenosine Deaminase / Q000378:metabolism; D000368:Aged; D000369:Aged, 80 and over; D001798:Blood Proteins / Q000378:metabolism; D002423:Cause of Death; D018450:Disease Progression; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008137:Longitudinal Studies; D018655:Lymphocyte Count; D008218:Lymphocytosis / Q000000981:diagnostic imaging / Q000201:enzymology / Q000209:etiology / Q000401:mortality*; D008297:Male; D010348:Patient Care Team; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000201:enzymology / Q000209:etiology / Q000401:mortality*; D016066:Pleural Effusion, Malignant / Q000000981:diagnostic imaging / Q000201:enzymology / Q000209:etiology / Q000401:mortality*; D011446:Prospective Studies; D011859:Radiography; D012075:Remission, Spontaneous; D016019:Survival Analysis; D015996:Survival Rate
D001798:Blood Proteins; D007770:L-Lactate Dehydrogenase; D000243:Adenosine Deaminase