Abstract
Pericardial effusion can dangerously precipitate patient’s hemodynamic stability and requires prompt intervention in case of tamponade. We investigated potential predictors of in-hospital mortality, a composite outcome of in-hospital mortality, pericardiocentesis-related complications, and the need for emergency cardiac surgery and all-cause mortality in patients undergoing percutaneous pericardiocentesis. This is an observational, retrospective, single-center study on patients undergoing percutaneous pericardiocentesis (2010–2019). We enrolled 81 consecutive patients. Median age was 71.4 years (interquartile range [IQR] 58.1–78.1 years) and 51 (63%) were male. Most of the pericardiocentesis were performed in an urgency setting (76.5%) for cardiac tamponade (77.8%). The most common etiology was idiopathic (33.3%) followed by neoplastic (22.2%). In-hospital mortality was 14.8% while mortality during follow-up (mean 17.1 months) was 44.4%. Only hemodynamic instability (i.e., cardiogenic shock, hypotension refractory to fluid challenge therapy and inotropes) was associated with in-hospital mortality at the univariate analysis (odds ratio [OR] 7.2; 95% confidence interval [CI] 1.76–29.4). Non-neoplastic/non-idiopathic etiology and hemodynamic instability were associated with the composite outcome of in-hospital mortality, need for emergency cardiac surgery, or pericardiocentesis-related complications (OR 5.75, 95% CI 1.65–20.01, and OR 5.81, 95% CI 2.11–15.97, respectively). Multivariate Cox regression analysis adjusted for possible confounding variables (age, coronary artery disease, and hemodynamic instability) showed that neoplastic etiology was independently associated with medium-term mortality (hazard ratio [HR] 4.05, 95% CI 1.45–11.36). In a real-world population treated with pericardiocentesis for pericardial effusion, in-hospital adverse outcomes and medium-term mortality are consistent, in particular for patients presenting with hemodynamic instability or neoplastic pericardial effusion.
Highlights
Pericardial effusion is a clinical condition characterized by an abnormal accumulation of fluid in the pericardial space
Regardless of the etiology, pericardial effusion is usually treated by percutaneous pericardiocentesis, which has a twofold purpose, therapeutic and diagnostic [11]
The aim of our study is to investigate the clinical characteristics of patients undergoing percutaneous pericardiocentesis and to evaluate possible predictors of adverse clinical outcomes and medium-term mortality according to different etiologies of pericardial effusion
Summary
Pericardial effusion is a clinical condition characterized by an abnormal accumulation of fluid in the pericardial space. Given the limited space in the pericardial cavity, fluid accumulation can severely impact patients’ hemodynamic status with dramatic clinical consequences. Internal and Emergency Medicine (2021) 16:1771–1777 or it can be programmed when the instrumental findings (echocardiography, cardiac tomography [CT] scan or magnetic resonance imaging [MRI]) and clinical characteristics of the patient suggest the possibility of an evolution towards cardiac tamponade [12, 13]. Chemical–physical examination, cytology and microbiology tests are essential steps in the diagnostic process aimed at delineating the exact etiology of pericardial effusion [14,15,16,17]. Given the great heterogeneity of patients included in the studies, it is not easy to identify potential predictors of mortality, and data available in the literature are scanty
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