Clinical characteristics of chylothorax: results from the International Collaborative Effusion database

José M Porcel; Silvia Bielsa; Carmen Civit; Avinash Aujayeb; Julius Janssen; Uffe Bodtger; Katrine Fjaellegaard; Jesper Koefod Petersen; Hugh Welch; Jenny Symonds; Michael A Mitchell; Elżbieta Magdalena Grabczak; Mohamed Ellayeh; Dinesh Addala; John M Wrightson; Najib M Rahman; Mohammed Munavvar; Coenraad F N Koegelenberg; Gonzalo Labarca; Federico Mei; Nick Maskell; Rahul Bhatnagar

doi:10.1183/23120541.00091-2023

Clinical characteristics of chylothorax: results from the International Collaborative Effusion database

José M Porcel^*, Silvia Bielsa, Carmen Civit, Avinash Aujayeb, Julius Janssen, Uffe Bodtger, Katrine Fjaellegaard, Jesper Koefod Petersen, Hugh Welch, Jenny Symonds, Michael A Mitchell, Elżbieta Magdalena Grabczak, Mohamed Ellayeh, Dinesh Addala, John M Wrightson, Najib M Rahman, Mohammed Munavvar, Coenraad F N Koegelenberg, Gonzalo Labarca, Federico MeiNick Maskell, Rahul Bhatnagar

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

BACKGROUND: Chylothorax is an uncommon medical condition for which limited data are available regarding the contemporary aetiology, management and outcomes. The goal of this study was to better define these poorly characterised features.

METHODS: The medical records of adult patients diagnosed with chylothorax at 12 centres across Europe, America and South Africa from 2009-2021 were retrospectively reviewed. Descriptive and inferential statistics were performed.

RESULTS: 77 patients (median age 69 years, male to female ratio 1.5) were included. Subacute dyspnoea was the most typical presenting symptom (66%). The commonest cause of chylothorax was malignancy (68.8%), with lymphoma accounting for 62% of these cases. Other aetiologies were trauma (13%), inflammatory/miscellaneous conditions (11.7%) and idiopathic cases (6.5%). At the initial thoracentesis, the pleural fluid appeared milky in 73%, was exudative in 89% and exhibited triglyceride concentrations >100 mg·dL -1 in 88%. Lymphangiography/lymphoscintigraphy were rarely ordered (3%), and demonstration of chylomicrons in pleural fluid was never ascertained. 67% of patients required interventional pleural procedures. Dietary measures were infrequently followed (36%). No patient underwent thoracic duct ligation or embolisation. Morbidity included infections (18%), and thrombosis in malignant aetiologies (16%). The 1-year mortality was 47%. Pleural fluid protein >3.5 mg·dL -1 (sub-distribution hazard ratio (SHR) 4.346) or lactate dehydrogenase <500 U·L -1 (SHR 10.21) increased the likelihood of effusion resolution. Pleural fluid protein ≤3.5 mg·dL -1 (HR 4.047), bilateral effusions (HR 2.749) and a history of respiratory disease (HR 2.428) negatively influenced survival.

CONCLUSION: Chylothoraces have a poor prognosis and most require pleural interventions. Despite the standard recommendations, lymphatic imaging is seldom used, nor are dietary restrictions followed.

Original language	English
Article number	00091-2023
Journal	ERJ Open Research
Volume	9
Issue number	5
Early online date	21 Sept 2023
DOIs	https://doi.org/10.1183/23120541.00091-2023
Publication status	Published - 16 Oct 2023

Bibliographical note

Access to Document

10.1183/23120541.00091-2023Licence: CC BY-NC

Handle.net

Persistent link

Cite this

Porcel, J. M., Bielsa, S., Civit, C., Aujayeb, A., Janssen, J., Bodtger, U., Fjaellegaard, K., Petersen, J. K., Welch, H., Symonds, J., Mitchell, M. A., Grabczak, E. M., Ellayeh, M., Addala, D., Wrightson, J. M., Rahman, N. M., Munavvar, M., Koegelenberg, C. F. N., Labarca, G., ... Bhatnagar, R. (2023). Clinical characteristics of chylothorax: results from the International Collaborative Effusion database. ERJ Open Research, 9(5), Article 00091-2023. https://doi.org/10.1183/23120541.00091-2023

@article{c2f1c0c7ceff4b778625e5780dd0cb31,

title = "Clinical characteristics of chylothorax: results from the International Collaborative Effusion database",

abstract = "BACKGROUND: Chylothorax is an uncommon medical condition for which limited data are available regarding the contemporary aetiology, management and outcomes. The goal of this study was to better define these poorly characterised features.METHODS: The medical records of adult patients diagnosed with chylothorax at 12 centres across Europe, America and South Africa from 2009-2021 were retrospectively reviewed. Descriptive and inferential statistics were performed.RESULTS: 77 patients (median age 69 years, male to female ratio 1.5) were included. Subacute dyspnoea was the most typical presenting symptom (66%). The commonest cause of chylothorax was malignancy (68.8%), with lymphoma accounting for 62% of these cases. Other aetiologies were trauma (13%), inflammatory/miscellaneous conditions (11.7%) and idiopathic cases (6.5%). At the initial thoracentesis, the pleural fluid appeared milky in 73%, was exudative in 89% and exhibited triglyceride concentrations >100 mg·dL -1 in 88%. Lymphangiography/lymphoscintigraphy were rarely ordered (3%), and demonstration of chylomicrons in pleural fluid was never ascertained. 67% of patients required interventional pleural procedures. Dietary measures were infrequently followed (36%). No patient underwent thoracic duct ligation or embolisation. Morbidity included infections (18%), and thrombosis in malignant aetiologies (16%). The 1-year mortality was 47%. Pleural fluid protein >3.5 mg·dL -1 (sub-distribution hazard ratio (SHR) 4.346) or lactate dehydrogenase <500 U·L -1 (SHR 10.21) increased the likelihood of effusion resolution. Pleural fluid protein ≤3.5 mg·dL -1 (HR 4.047), bilateral effusions (HR 2.749) and a history of respiratory disease (HR 2.428) negatively influenced survival. CONCLUSION: Chylothoraces have a poor prognosis and most require pleural interventions. Despite the standard recommendations, lymphatic imaging is seldom used, nor are dietary restrictions followed.",

author = "Porcel, {Jos{\'e} M} and Silvia Bielsa and Carmen Civit and Avinash Aujayeb and Julius Janssen and Uffe Bodtger and Katrine Fjaellegaard and Petersen, {Jesper Koefod} and Hugh Welch and Jenny Symonds and Mitchell, {Michael A} and Grabczak, {El{\.z}bieta Magdalena} and Mohamed Ellayeh and Dinesh Addala and Wrightson, {John M} and Rahman, {Najib M} and Mohammed Munavvar and Koegelenberg, {Coenraad F N} and Gonzalo Labarca and Federico Mei and Nick Maskell and Rahul Bhatnagar",

note = "Copyright {\textcopyright}The authors 2023.",

year = "2023",

month = oct,

day = "16",

doi = "10.1183/23120541.00091-2023",

language = "English",

volume = "9",

journal = "ERJ Open Research",

issn = "2312-0541",

publisher = "European Respiratory Society",

number = "5",

}

Porcel, JM, Bielsa, S, Civit, C, Aujayeb, A, Janssen, J, Bodtger, U, Fjaellegaard, K, Petersen, JK, Welch, H, Symonds, J, Mitchell, MA, Grabczak, EM, Ellayeh, M, Addala, D, Wrightson, JM, Rahman, NM, Munavvar, M, Koegelenberg, CFN, Labarca, G, Mei, F, Maskell, N & Bhatnagar, R 2023, 'Clinical characteristics of chylothorax: results from the International Collaborative Effusion database', ERJ Open Research, vol. 9, no. 5, 00091-2023. https://doi.org/10.1183/23120541.00091-2023

TY - JOUR

T1 - Clinical characteristics of chylothorax

T2 - results from the International Collaborative Effusion database

AU - Porcel, José M

AU - Bielsa, Silvia

AU - Civit, Carmen

AU - Aujayeb, Avinash

AU - Janssen, Julius

AU - Bodtger, Uffe

AU - Fjaellegaard, Katrine

AU - Petersen, Jesper Koefod

AU - Welch, Hugh

AU - Symonds, Jenny

AU - Mitchell, Michael A

AU - Grabczak, Elżbieta Magdalena

AU - Ellayeh, Mohamed

AU - Addala, Dinesh

AU - Wrightson, John M

AU - Rahman, Najib M

AU - Munavvar, Mohammed

AU - Koegelenberg, Coenraad F N

AU - Labarca, Gonzalo

AU - Mei, Federico

AU - Maskell, Nick

AU - Bhatnagar, Rahul

PY - 2023/10/16

Y1 - 2023/10/16

N2 - BACKGROUND: Chylothorax is an uncommon medical condition for which limited data are available regarding the contemporary aetiology, management and outcomes. The goal of this study was to better define these poorly characterised features.METHODS: The medical records of adult patients diagnosed with chylothorax at 12 centres across Europe, America and South Africa from 2009-2021 were retrospectively reviewed. Descriptive and inferential statistics were performed.RESULTS: 77 patients (median age 69 years, male to female ratio 1.5) were included. Subacute dyspnoea was the most typical presenting symptom (66%). The commonest cause of chylothorax was malignancy (68.8%), with lymphoma accounting for 62% of these cases. Other aetiologies were trauma (13%), inflammatory/miscellaneous conditions (11.7%) and idiopathic cases (6.5%). At the initial thoracentesis, the pleural fluid appeared milky in 73%, was exudative in 89% and exhibited triglyceride concentrations >100 mg·dL -1 in 88%. Lymphangiography/lymphoscintigraphy were rarely ordered (3%), and demonstration of chylomicrons in pleural fluid was never ascertained. 67% of patients required interventional pleural procedures. Dietary measures were infrequently followed (36%). No patient underwent thoracic duct ligation or embolisation. Morbidity included infections (18%), and thrombosis in malignant aetiologies (16%). The 1-year mortality was 47%. Pleural fluid protein >3.5 mg·dL -1 (sub-distribution hazard ratio (SHR) 4.346) or lactate dehydrogenase <500 U·L -1 (SHR 10.21) increased the likelihood of effusion resolution. Pleural fluid protein ≤3.5 mg·dL -1 (HR 4.047), bilateral effusions (HR 2.749) and a history of respiratory disease (HR 2.428) negatively influenced survival. CONCLUSION: Chylothoraces have a poor prognosis and most require pleural interventions. Despite the standard recommendations, lymphatic imaging is seldom used, nor are dietary restrictions followed.

AB - BACKGROUND: Chylothorax is an uncommon medical condition for which limited data are available regarding the contemporary aetiology, management and outcomes. The goal of this study was to better define these poorly characterised features.METHODS: The medical records of adult patients diagnosed with chylothorax at 12 centres across Europe, America and South Africa from 2009-2021 were retrospectively reviewed. Descriptive and inferential statistics were performed.RESULTS: 77 patients (median age 69 years, male to female ratio 1.5) were included. Subacute dyspnoea was the most typical presenting symptom (66%). The commonest cause of chylothorax was malignancy (68.8%), with lymphoma accounting for 62% of these cases. Other aetiologies were trauma (13%), inflammatory/miscellaneous conditions (11.7%) and idiopathic cases (6.5%). At the initial thoracentesis, the pleural fluid appeared milky in 73%, was exudative in 89% and exhibited triglyceride concentrations >100 mg·dL -1 in 88%. Lymphangiography/lymphoscintigraphy were rarely ordered (3%), and demonstration of chylomicrons in pleural fluid was never ascertained. 67% of patients required interventional pleural procedures. Dietary measures were infrequently followed (36%). No patient underwent thoracic duct ligation or embolisation. Morbidity included infections (18%), and thrombosis in malignant aetiologies (16%). The 1-year mortality was 47%. Pleural fluid protein >3.5 mg·dL -1 (sub-distribution hazard ratio (SHR) 4.346) or lactate dehydrogenase <500 U·L -1 (SHR 10.21) increased the likelihood of effusion resolution. Pleural fluid protein ≤3.5 mg·dL -1 (HR 4.047), bilateral effusions (HR 2.749) and a history of respiratory disease (HR 2.428) negatively influenced survival. CONCLUSION: Chylothoraces have a poor prognosis and most require pleural interventions. Despite the standard recommendations, lymphatic imaging is seldom used, nor are dietary restrictions followed.

U2 - 10.1183/23120541.00091-2023

DO - 10.1183/23120541.00091-2023

M3 - Article (Academic Journal)

C2 - 37850216

SN - 2312-0541

VL - 9

JO - ERJ Open Research

JF - ERJ Open Research

IS - 5

M1 - 00091-2023

ER -

Clinical characteristics of chylothorax: results from the International Collaborative Effusion database

Abstract

Bibliographical note

Access to Document

Handle.net

Fingerprint

Cite this