Figures
- FIGURE 1
Change in a) pleural opacity, b) serum C-reactive protein and c) serum leukocyte counts over time according to the type of fibrinolysis. There were no differences in these variables between groups (p>0.05). t-PA: tissue plasminogen activator.
Tables
- TABLE 1
Patient characteristics
Characteristics Overall Urokinase t-PA/DNAse p-value Patients 93 52 41 Age years 61.5±17.2 61.4±17.6 61.6±17 0.95 Males 63 (68%) 39 (75%) 24 (59%) 0.09 Right-sided effusion 55 (59%) 28 (54%) 27 (66%) 0.24 Presence of lung cancer 16 (17%) 7 (13%) 9 (22%) 0.28 Pleural fluid analyses 93 (100%) Positive bacterial culture 33 (35%) 16 (31%) 17 (41%) 0.28 pH 7±0.4 7±0.2 6.9±0.4 0.63 Glucose mmol·L−1 3.5±8.1 3.9±9.9 2.8±4.4 0.59 Lactate dehydrogenase IU·L−1 2217±2676 2447±3171 1912±1831 0.38 Radiological findings Area occupied by effusion at baseline % 39.4±19.6 38.8±20 40.1±19.4 0.76 CT scan 86 (92%) 47 (90%) 39 (95%) 0.39 Number of collections 2.5±1.4 2.4±1.4 2.6±1.5 0.46 Isolated if ≥2 collections 39 (64%) 22 (71%) 17 (57%) 0.24 Drainage Image-guided procedure 76 (82%) 38 (73%) 38 (93%) 0.02 Tube size French 13.7±4 14.5±4.8 12.6±2.4 0.02 Hospitalisation-to-drainage duration days 3 (1–8) 2 (0–7) 3 (2–9) 0.31 Drainage-to-lysis duration days 1 (0–2) 1 (0–2) 1 (0–2) 0.23 Data are presented as mean±sd or median (interquartile range), unless otherwise stated. t-PA: tissue plasminogen activator; CT: computed tomography.
- TABLE 2
Clinical outcomes
Clinical outcomes Overall Urokinase t-PA/DNAse p-value Additional procedure 32 (34%) 20 (38%) 12 (29%) 0.35 Surgical referral 12 (13%) 8 (15%) 4 (10%) 0.42 Additional chest tube 20 (21%) 12 (23%) 8 (19%) 0.68 Duration of fibrinolysis days 3 (3–5) 5 (4–7) 3 (3–3) <0.001 Duration of drainage days 6 (4–9) 7 (4–10) 6 (5–8) 0.05 Change in area occupied by effusion from baseline % On day 3 −19.3±17.9 −19.4±16 −19.1±20.2 0.94 On day 7 −28.7±18 −26.9±19.2 −30.8±16.7 0.38 Change in serum CRP level from baseline mg·dL−1 On day 3 −82.3±86.2 −70.4±76.1 −96.8±96 0.15 On day 7 −131±109.2 −104.6±99.7 −163.7±112.4 0.01 Change in blood leukocyte count from baseline ×109 L−1 On day 3 −2.2±4.2 −1.6±4.3 −2.9±4 0.15 On day 7 −3.8±5.8 −2.1±5.4 −5.9±5.5 0.002 Complications of fibrinolysis 7 (8%) 0 (0%) 7 (17%) 0.002 Length of stay days 18 (11–26) 18 (11–25) 18 (11–32) 0.12 Death at 30 days 6 (6%) 4 (8%) 2 (5%) 0.58 Data are presented as median (interquartile range) or mean±sd unless otherwise stated. t-PA: tissue plasminogen activator; CRP: C-reactive protein.
- TABLE 3
Odds ratios for failure of fibrinolysis and subgroup surgical referral, determined using a univariate logistic regression model
Covariate Additional procedure Surgical referral OR (95% CI) p-value OR (95% CI) p-value Urokinase versus t-PA/DNAse 0.66 (0.28–1.59) 0.36 0.59 (0.17–2.13) 0.43 Age 1 (0.97–1.02) 0.95 0.99 (0.95–1.02) 0.45 Positive bacterial culture 1.71 (0.71–4.16) 0.23 2 (0.59–6.79) 0.27 Hospitalisation-to-drainage duration 0.93 (0.85–1.01) 0.07 0.87 (0.72–1.05) 0.14 Drainage-to-lysis duration 1.13 (0.93–1.36) 0.22 1.19 (0.96–1.47) 0.12 Non-image-guided versus image-guided procedure 2.59 (0.89–7.56) 0.08 0.88 (0.17–4.44) 0.88 Tube size (ref. 8–12 French) 14–18 French 1.06 (0.4–2.78) 0.91 1.54 (0.41–5.79) 0.53 20–24 French 4.86 (1.26–18.77) 0.02 1.72 (0.29–10.18) 0.55 Duration of fibrinolysis 1.18 (0.98–1.41) 0.08 1.05 (0.83–1.33) 0.66 Duration of drainage (ref. 1–3 days) 4–10 days 1.25 (0.31–5.1) 0.76 0.57 (0.1–3.16) 0.52 >10 days 6.75 (1.16–39.2) 0.03 1.5 (0.2–11) 0.69 Baseline area occupied by effusion (ref. ≤1/3) 1/3 to 2/3 of the hemithorax 2.94 (1.02–8.5) 0.04 1.69 (0.4–7.1) 0.47 >2/3 of the hemithorax 4.33 (1.1–17.1) 0.04 1.61 (0.24–10.9) 0.49 One versus multiple collections 4.81 (1.48–15.66) 0.009 2.53 (0.49–11.82) 0.31 Isolated versus grouped collections 1.27 (0.43–3.69) 0.67 2.45 (0.47–12.78) 0.29 t-PA: tissue plasminogen activator.
- TABLE 4
Odds ratios for failure of fibrinolysis and subgroup surgical referral, determined using a multivariate logistic regression model
Covariate Additional procedure Surgical referral OR (95% CI) p-value OR (95% CI) p-value Urokinase versus t-PA/DNase 0.69 (0.25–1.91) 0.48 0.52 (0.14–2.02) 0.35 Tube size (ref. 8–12 French) 14–18 French 1.1 (0.39–3.14) 0.85 1.71 (0.44–6.69) 0.44 20–24 French 11.19 (1.7–73.9) 0.01 1.67 (0.26–10.78) 0.59 One versus multiple collections 6.58 (1.68–25.73) 0.007 2.44 (0.48–12.26) 0.28 t-PA: tissue plasminogen activator.
- TABLE 5
Cost of injections
Cost Urokinase t-PA/DNAse p-value Cost per injection CHF 144.45 229.17 NA Cost per patient CHF mean±sd 1550.06±101.92 1263.23±530.37 0.04 t-PA: tissue plasminogen activator; NA: not applicable.
Supplementary Material
Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.
FIGURE S1 Measurement of percentage of opacity using chest radiography in posteroanterior view: the area of effusion (right) was divided by the area of the chest (left). The landmarks were the spine, lateral edge of the chest wall and diaphragm. Area measurements (in mm2) were performed using the Weasis software v2.6.3 (HUG, Geneva, Switzerland). 00084-2019
