The British Thoracic Association

Abstract

To determine the prognostic value of pleuralfluid pH, pleural fluid glucose, extent of pleural carcinomatosis (EPC)score, and Karnofsky Performance Scale (KPS) score in patients withrecurrent symptomatic malignant pleural effusions.Prospective 53-month study.Referral center for interventionalpulmonology.Eighty-five consecutivepatients (42 men and 43 women) with recurrent symptomatic malignantpleural effusions who were referred to the interventional pulmonaryservice for thoracoscopic pleurodesis.Pleural fluid pH, pleural fluid glucose, EPC score, and KPS score.The KPS score was the only statisticallysignificant predictor variable. Patients with a KPS score ≥ 70 had amedian survival of 395 days, as opposed to a median survival of only 34days for patients with a KPS score ≤ 30. No prognostic advantage wasevident when patients were categorized by pleural fluid pH, pleuralfluid glucose, or EPC score.Whenassessing the prognosis of a patient with a recurrent symptomaticmalignant pleural effusion, only the KPS score at the time ofthoracoscopy is predictive of survival. Pleural fluid pH, pleural fluidglucose, and EPC scores are not as reliable as initially reported. Forpatients with a KPS score ≥ 70, it may be very reasonable to proceedwith thoracoscopic talc pleurodesis for management of their malignantpleural effusions.