Pleural Fluid pH as a Predictor of Survival for Patients With Malignant Pleural Effusions

To assess the accuracy of pleuralfluid (PF) pH in predicting duration of survival of patients withmalignant pleural effusions. Analysis ofpatient-level data from nine sources retrieved from a MEDLINE searchand correspondence with primary investigators. Published and unpublished studies that report P...

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Veröffentlicht in:Chest 2000-01, Vol.117 (1), p.79-86
Hauptverfasser: Heffner, John E., Nietert, Paul J., Barbieri, Celia
Format: Artikel
Sprache:eng
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Zusammenfassung:To assess the accuracy of pleuralfluid (PF) pH in predicting duration of survival of patients withmalignant pleural effusions. Analysis ofpatient-level data from nine sources retrieved from a MEDLINE searchand correspondence with primary investigators. Published and unpublished studies that report PF pH values and duration of survival of patients with malignant pleuraleffusions. Primaryinvestigators supplied patient-level data (n = 417), which wasexamined by receiver operating characteristic (ROC) analysis, logisticregression, and survival time modeling to determine the utility of PFpH for predicting survival compared with other clinical factors. Theprimary investigations were graded for study design. Median survival (n = 417) was4.0 months: PF pH (p < 0.0039) was an independent predictor ofsurvival duration. A PF pH test threshold ≤ 7.28 had the highestaccuracy for identifying poor 1-, 2-, and 3-month survivals. Thepredictive accuracies of PF pH (area under the ROC curve range, 0.571to 0.662) and a PF pH–high-risk tumor (lung, soft tissues, renal, ovary, gastrointestinal, prostate, and oropharynx) model (odds ratiorange, 2.91 to 6.67), however, were modest for predicting 1-, 2-, and3-month survival. Only 54.4% and 62.7% of patients identified by PFpH ≤ 7.28 or the PF pH–high-risk tumor model to die within 3 monthswere correctly classified. Weaknesses of the primary data wereidentified. PF pH has insufficientpredictive accuracy for selecting patients for pleurodesis on the basisof estimated survival.
ISSN:0012-3692
1931-3543
DOI:10.1378/chest.117.1.79