TY - JOUR
T1 - Association between tunneled pleural catheter use and infection in patients immunosuppressed from antineoplastic therapy
T2 - A multicenter study
AU - Wilshire, Candice L.
AU - Chang, Shu Ching
AU - Gilbert, Christopher R.
AU - Akulian, Jason A.
AU - AlSarraj, Mohammed K.
AU - Asciak, Rachelle
AU - Bevill, Benjamin T.
AU - Davidson, Kevin R.
AU - Delgado, Ashley
AU - Grosu, Horiana B.
AU - Herth, Felix J.F.
AU - Lee, Hans J.
AU - Lewis, Justin E.
AU - Maldonado, Fabien
AU - Ost, David E.
AU - Pastis, Nicholas J.
AU - Rahman, Najib M.
AU - Reddy, Chakravarthy B.
AU - Roller, Lance J.
AU - Sanchez, Trinidad M.
AU - Shojaee, Samira
AU - Steer, Henry
AU - Thiboutot, Jeffrey
AU - Wahidi, Momen M.
AU - Wright, Amber N.
AU - Yarmus, Lonny B.
AU - Gorden, Jed A.
N1 - Publisher Copyright:
Copyright © 2021 by the American Thoracic Society
PY - 2021/4
Y1 - 2021/4
N2 - Rationale: Patients with malignant or paramalignant pleural effusions (MPEs or PMPEs) may have tunneled pleural catheter (TPC) management withheld because of infection concerns from immunosuppression associated with antineoplastic therapy. Objectives: To determine the rate of infections related to TPC use and to determine the relationship to antineoplastic therapy, immune system competency, and overall survival (OS). Methods: We performed an international, multiinstitutional study of patients with MPEs or PMPEs undergoing TPC management from 2008 to 2016. Patients were stratified by whether or not they underwent antineoplastic therapy and/or whether or not they were immunocompromised. Cumulative incidence functions and multivariable competing risk regression analyses were performed to identify independent predictors of TPC-related infection. Kaplan-Meier method and multivariable Cox proportional hazards modeling were performed to examine for independent effects on OS. Results: A total of 1,408 TPCs were placed in 1,318 patients. Patients had a high frequency of overlap between antineoplastic therapy and an immunocompromised state (75-83%). No difference in the overall (6-7%), deep pleural (3-5%), or superficial (3-4%) TPC-related infection rates between subsets of patients stratified by antineoplastic therapy or immune status was observed. The median time to infection was 41 (interquartile range, 19-87) days after TPC insertion. Multivariable competing risk analyses demonstrated that longer TPC duration was associated with a higher risk of TPC-related infection (subdistribution hazard ratio, 1.03; 95% confidence interval [CI], 1.00-1.06; P = 0.028). Cox proportional hazards analysis showed antineoplastic therapy was associated with better OS (hazard ratio, 0.84; 95% CI, 0.73-0.97; P = 0.015). Conclusions: The risk of TPC-related infection does not appear to be increased by antineoplastic therapy use or an immunocompromised state. The overall rates of infection are low and comparable with those of immunocompetent patients with no relevant antineoplastic therapy. These results support TPC palliation for MPE or PMPEs regardless of plans for antineoplastic therapy.
AB - Rationale: Patients with malignant or paramalignant pleural effusions (MPEs or PMPEs) may have tunneled pleural catheter (TPC) management withheld because of infection concerns from immunosuppression associated with antineoplastic therapy. Objectives: To determine the rate of infections related to TPC use and to determine the relationship to antineoplastic therapy, immune system competency, and overall survival (OS). Methods: We performed an international, multiinstitutional study of patients with MPEs or PMPEs undergoing TPC management from 2008 to 2016. Patients were stratified by whether or not they underwent antineoplastic therapy and/or whether or not they were immunocompromised. Cumulative incidence functions and multivariable competing risk regression analyses were performed to identify independent predictors of TPC-related infection. Kaplan-Meier method and multivariable Cox proportional hazards modeling were performed to examine for independent effects on OS. Results: A total of 1,408 TPCs were placed in 1,318 patients. Patients had a high frequency of overlap between antineoplastic therapy and an immunocompromised state (75-83%). No difference in the overall (6-7%), deep pleural (3-5%), or superficial (3-4%) TPC-related infection rates between subsets of patients stratified by antineoplastic therapy or immune status was observed. The median time to infection was 41 (interquartile range, 19-87) days after TPC insertion. Multivariable competing risk analyses demonstrated that longer TPC duration was associated with a higher risk of TPC-related infection (subdistribution hazard ratio, 1.03; 95% confidence interval [CI], 1.00-1.06; P = 0.028). Cox proportional hazards analysis showed antineoplastic therapy was associated with better OS (hazard ratio, 0.84; 95% CI, 0.73-0.97; P = 0.015). Conclusions: The risk of TPC-related infection does not appear to be increased by antineoplastic therapy use or an immunocompromised state. The overall rates of infection are low and comparable with those of immunocompetent patients with no relevant antineoplastic therapy. These results support TPC palliation for MPE or PMPEs regardless of plans for antineoplastic therapy.
KW - Antineoplastic therapy immunosuppression
KW - Pleural infection
KW - Tunneled pleural catheter
UR - http://www.scopus.com/inward/record.url?scp=85103508748&partnerID=8YFLogxK
U2 - 10.1513/AnnalsATS.202007-886OC
DO - 10.1513/AnnalsATS.202007-886OC
M3 - Article
C2 - 33026887
AN - SCOPUS:85103508748
SN - 2329-6933
VL - 18
SP - 606
EP - 612
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 4
ER -