Chest
Clinical InvestigationsPLEURAL DISEASEPleural Fluid pH as a Predictor of Pleurodesis Failure: Analysis of Primary Data
Section snippets
Article Selection
We searched MEDLINE for pertinent articles using pH, pleural fluid, pleural effusions, pleural malignancy, malignant effusions, and pleurodesis as key words. The articles were examined to determine whether reference was made to the utility of pH for predicting pleurodesis outcome for patients with documented malignant pleural effusions. The reference lists of relevant articles were reviewed to identify additional articles and abstracts. We also queried several experts on pleural disease and the
Sources of Information
The data search identified 11 articles,4, 56, 78, 910, 1112, 13, 14 4 abstracts,25, 2627, 28 and 1 letter 29 that reported outcomes of pleurodesis and pH values. All of the abstracts were excluded because their data were subsequently reported in the retrieved articles. The letter reported data that partially overlapped with a subsequent article; the investigator supplied data for these patients, which allowed the removal of duplicate data from analysis.
One investigator indicated that
Discussion
Our analysis of original, patient-level data from published studies demonstrates that pleural fluid pH has only modest (AUC, 0.671) discriminative properties for identifying patients who will experience symptomatic failure of pleurodesis. Pleural fluid pH did not have a greater predictive accuracy when compared by ROC analysis to glucose or %LDH for predicting symptomatic failure. Although pleural fluid pH had only modest discriminative properties, it was the only pleural fluid test that was an
ACKNOWLEDGMENTS
The authors thank Drs. Steven A. Sahn and Marc Silverstein for reviewing the manuscript.
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