Analyzing pleural fluid attributes in SARS-CoV-2 infection: a systematic review

Area of Science:

• Pulmonology
• Infectious Diseases
• Critical Care Medicine

Background:

• Characteristics of pleural fluid (PF) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remain unclear.
• Pleural effusion (PE) has been reported in coronavirus disease 2019 (COVID-19) patients, but conclusive features are lacking.

Purpose of the Study:

• To systematically review and summarize available evidence on pleural fluid attributes in SARS-CoV-2 infected patients.
• To analyze PF characteristics and treatment strategies for PE in COVID-19.

Main Methods:

• Systematic literature search adhering to PRISMA methodology.
• Inclusion of 18 articles detailing PF characteristics and PE treatment in SARS-CoV-2 patients.
• Analysis of data from 32 patients and 37 PF samples.

Main Results:

• Pleural effusion (PE) predominantly affected males (5.4:1 ratio), aged 61 years median, and was typically unilateral (71.4%) and large.
• PF analysis revealed exudative fluid (88.9%) with variable appearance (serous, hematic, purulent) and predominantly neutrophilic infiltration.
• SARS-CoV-2 PCR was positive in 26.1% of PF samples; PE in COVID-19 patients was associated with a 40% mortality rate.

Conclusions:

• COVID-19-associated PE is more common in males aged 50-80 years, often unilateral and large.
• PF in COVID-19 exhibits exudative, neutrophilic features and requires standard PE treatment.
• PE in COVID-19 signifies a poor prognostic indicator, correlating with increased mortality.