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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Clinical characteristics of chylothorax: results from the International Collaborative Effusion database
ERJ Open Research, Volume 9, No. 5, Article 00091-2023, Year 2023
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Description
Background Chylothorax is an uncommon medical condition for which limited data are available regarding the contemporary aetiology, management and outcomes. The goal of this study was to better define these poorly characterised features. Methods The medical records of adult patients diagnosed with chylothorax at 12 centres across Europe, America and South Africa from 2009–2021 were retrospectively reviewed. Descriptive and inferential statistics were performed. Results 77 patients (median age 69 years, male to female ratio 1.5) were included. Subacute dyspnoea was the most typical presenting symptom (66%). The commonest cause of chylothorax was malignancy (68.8%), with lymphoma accounting for 62% of these cases. Other aetiologies were trauma (13%), inflammatory/miscellaneous conditions (11.7%) and idiopathic cases (6.5%). At the initial thoracentesis, the pleural fluid appeared milky in 73%, was exudative in 89% and exhibited triglyceride concentrations >100 mg·dL−1 in 88%. Lymphangiography/lymphoscintigraphy were rarely ordered (3%), and demonstration of chylomicrons in pleural fluid was never ascertained. 67% of patients required interventional pleural procedures. Dietary measures were infrequently followed (36%). No patient underwent thoracic duct ligation or embolisation. Morbidity included infections (18%), and thrombosis in malignant aetiologies (16%). The 1-year mortality was 47%. Pleural fluid protein >3.5 mg·dL−1 (sub-distribution hazard ratio (SHR) 4.346) or lactate dehydrogenase <500 U·L−1 (SHR 10.21) increased the likelihood of effusion resolution. Pleural fluid protein ⩽3.5 mg·dL−1 (HR 4.047), bilateral effusions (HR 2.749) and a history of respiratory disease (HR 2.428) negatively influenced survival. Conclusion Chylothoraces have a poor prognosis and most require pleural interventions. Despite the standard recommendations, lymphatic imaging is seldom used, nor are dietary restrictions followed. © The authors 2023.
Authors & Co-Authors
Bielsa, Silvia
Spain, Lleida
Instituto de Investigación Biomédica de Lleida Fundació Dr. Pifarré
Aujayeb, Avinash
United Kingdom, North Shields
Northumbria Healthcare Nhs Foundation Trust
Janssen, Julius P.
Netherlands, Nijmegen
Canisius Wilhelmina Ziekenhuis
Bødtger, Uffe
Denmark, Roskilde
Sjællands Universitetshospital
Fjællegaard, Katrine
Denmark, Roskilde
Sjællands Universitetshospital
Petersen, Jesper Koefod
Denmark, Roskilde
Sjællands Universitetshospital
Welch, Hugh
United Kingdom, Bristol
University of Bristol
United Kingdom, Bristol
North Bristol Nhs Trust
Symonds, Jenny
United Kingdom, Bristol
North Bristol Nhs Trust
Mitchell, Michael Andrew
Canada, London
Western University
Ellayeh, Mohamed
Egypt, Mansoura
Mansoura University
United Kingdom, Oxford
Oxford University Hospitals Nhs Foundation Trust
Addala, Dinesh Narayan
United Kingdom, Oxford
Oxford University Hospitals Nhs Foundation Trust
Wrightson, John M.
United Kingdom, Oxford
Oxford University Hospitals Nhs Foundation Trust
Rahman, Najib Mahboob
United Kingdom, Oxford
Oxford University Hospitals Nhs Foundation Trust
United Kingdom, Oxford
Nihr Oxford Biomedical Research Centre
Koegelenberg, Coenraad F.N.
South Africa, Tygerberg
Tygerberg Hospital
Mei, Federico
Italy, Ancona
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Italy, Ancona
Università Politecnica Delle Marche
Maskell, Nick Anthony
United Kingdom, Bristol
University of Bristol
United Kingdom, Bristol
North Bristol Nhs Trust
Bhatnagar, Rahul
United Kingdom, Bristol
University of Bristol
United Kingdom, Bristol
North Bristol Nhs Trust
Statistics
Authors: 17
Affiliations: 16
Identifiers
Doi:
10.1183/23120541.00091-2023
ISSN:
23120541
Research Areas
Cancer
Environmental
Health System And Policy
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
South Africa
Participants Gender
Male
Female