The impact of comorbidities on diagnosis and treatment of pleural effusions of various origins

Relevance. The incidence comorbidities increases and and types of comorbidities change with the patient’s age. The severity can be assessed using multiple scales. The aim of this study was to identify the specifics of surgical intervention tactics to be used for treatment of pleural effusions of various etiologies, depending on comorbidities.

Methods. Comorbid pathology was assessed in 424 patients with pleural effusions of various origins using three indices developed by Charlson, Karnovsky, and the European Joint Oncological Group (ECOG). Thoracentesis, drainage of the pleural cavity, and videothoracoscopy with pleural biopsy were used for diagnosis and treatment.

Results. HIV, chronic hepatitis, and diseases of the gastrointestinal tract represented the most common comorbid pathologies in patients below the age of 49; cardiovascular diseases and diabetes mellitus were the most common comorbidities in patients after the age of 50. The Charlson's index was 2.6 ± 2.5 for patients younger than 39, 7.9 ± 2.7 for patients in the age range between 60 and 69, and 9.5 ± 2.5 for patients who were older than 70. 34 patients underwent pleural punctures as treatment of small and medium effusions with the Karnowski index less than 40 % and ECOG of 3 — 4 points; 33 resuscitated patients with more severe pathology underwent pleural cavity drainage due to large effusions without fragmentation. 355 patients underwent video thoracoscopy with pleural biopsy; 135 patients received intraoperative pleurodesis by insufflation of talcum powder, and 19 patients had trichloroacetic acid applied to the pleura. 17 (4%) patients died from worsening of the underlying disease and decompensation, including one case of myocardial infarction. Patients with fatal outcome had the Charlson's index of 9.4 ± 3.9, and survivors — 6.9 ± 3.1.

Conclusion. Worsening of main pathology and comorbidities, age over 60, Charlson's comorbidity index higher than 8, and an unfavorable prognosis for pleural effusions of various origins serve as an indication for the most conservative diagnostic and treatment approach.

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