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Pleural Fluid pH in Malignant Effusions: Diagnostic, Prognostic, and Therapeutic Implications

[+] Article, Author, and Disclosure Information

▸ Requests for reprints should be addressed to Steven A. Sahn, M.D.; Director, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 171 Ashley Avenue; Charleston, SC 29425.

Charleston, South Carolina; and Denver, Colorado

© 1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;108(3):345-349. doi:10.7326/0003-4819-108-3-345
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Study Objective: To determine whether the measurement of pleural fluid pH in malignant effusions has diagnostic use, predicts survival, and has therapeutic implications.

Design: A prospective comparison of cytologic examinations and pleural biopsy results, survival, and response to chemical pleurodesis with tetracycline in patients with normal-pH (7.30 or greater) and low-pH (less than 7.30) malignant pleural effusions.

Setting: Academic medical center, university referral hospital, city hospital, and Veterans Administration hospital.

Patients: Sixty patients with malignant pleural effusions, proven at either initial thoracentesis by cytologic examination or within 4 months of initial thoracentesis by repeat thoracentesis, thoracotomy, or autopsy, were followed until death.

Intervention: Twenty-one patients, 12 with normal pleural fluid pH and 9 with low pleural fluid pH, were treated with tube thoracostomy and intrapleural tetracycline for symptomatic, recurrent pleural effusions.

Main Results: The 20 patients with low-pH malignant effusions had a significantly greater positivity on initial pleural fluid cytologic evaluation, a shorter mean survival, and a poorer response to tetracycline pleurodesis compared with 40 patients with normal-pH malignant effusions.

Conclusions: Determination of pleural fluid pH in malignant effusions provides a rational approach to further diagnostic testing, prognostic information, and a rationale for palliative treatment.





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