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Multilevel and continuous pleural fluid pH likelihood ratios for evaluating malignant pleural effusions.
John E Heffner1, John N Heffner, Lee K Brown
1Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. heffnerj@musc.edu
Chest
|June 11, 2003
Summary
Pleural fluid pH has limited value in predicting death after pleurodesis for malignant pleural effusions. However, it is useful for estimating pleurodesis failure, with continuous likelihood ratios offering the most insight.
Area of Science:
- Pulmonology
- Oncology
- Medical Diagnostics
Background:
- Expert consensus recommends pleural fluid pH testing for malignant pleural effusions to guide pleurodesis.
- Existing studies suggest a link between pleural fluid pH and outcomes post-pleurodesis, but clinical application remains unclear.
Purpose of the Study:
- To quantitatively assess methods for deriving likelihood ratios from pleural fluid pH.
- To evaluate the role of pleural fluid pH in selecting patients for pleurodesis.
Main Methods:
- Systematic review of MEDLINE, reference lists, and author contact.
- Inclusion of studies assessing pleural fluid pH impact on survival and pleurodesis failure in malignant pleural effusions.
- Data extraction from electronic spreadsheets provided by primary authors.
Main Results:
- Analysis of data from 417 patients for survival and 433 for pleurodesis failure.
- Calculation of binary, multilevel, and continuous likelihood ratios for death and pleurodesis failure.
- Pleural fluid pH showed marginal performance for predicting short-term survival; binary likelihood ratios were comparable to other strategies.
Conclusions:
- Pleural fluid pH has limited value in predicting 3-month mortality post-pleurodesis, with binary likelihood ratios (cut-point ≤7.20) performing adequately.
- Pleural fluid pH is more valuable for predicting pleurodesis failure, with continuous likelihood ratios providing the most informative data.