Clinical Question: Does the presence of a clinically significant pleural effusion have an impact on survival in patients with an admitting diagnosis of cancer, congestive heart failure (CHF), or pneumonia?
Background: Pleural effusions are a common complication of cancer, CHF, and pneumonia. They are associated with increased healthcare utilization and reduced quality of life. Studies on malignant and nonmalignant pleural effusions have shown poor survival, but these studies were limited by a small sample size or lack of control groups.
Study Design: Retrospective cohort study
Setting: U.S. Veterans Affairs hospitals between January 1, 2000, and December 31, 2020
Synopsis: A total of 827,028 patients with a single admitting diagnosis of cancer, CHF, or pneumonia were identified. Patients were defined as having a clinically significant pleural effusion (PE) if they required pleural drainage. The remaining patients either had a pleural effusion not requiring drainage or no pleural effusion (NO-PE). There were 34,707 patients with PE and 792,217 with NO-PE; 104 patients were excluded for missing data. Median survival was significantly shorter among patients with PE across all diagnoses: cancer (PE, 1.33 years; CI, 1.27 to 1.39 versus NO-PE, 2.05 years; CI, 2.02 to 2.08), CHF (PE, 1.51 years; CI, 1.40 to 1.61 versus NO-PE, 3.23 years; CI, 3.21 to 3.26), and pneumonia (PE, 4.27 years; CI, 3.94 to 4.61 versus NO-PE, 5.11 years; CI, 5.06 to 5.15).
Limitations of the study include reliance on ICD and CPT coding to identify and classify patients, inability to adjust for disease severity, and a predominantly male cohort.
Bottom Line: A pleural effusion requiring drainage is an independent marker of poor prognosis for patients with cancer, CHF, or pneumonia.
Citation: Chopra A, et al. The impact of clinically significant pleural effusion on survival of US veterans with cancer, congestive heart failure, and pneumonia: the Veterans Administration Lung Effusion Study. Chest. 2025;168(2):531-538. doi:10.1016/j.chest.2025.02.003.
Dr. Maguire
Dr. Maguire is an academic hospitalist in the division of hospital medicine at MedStar Washington Hospital Center and an assistant professor of medicine at Georgetown University School of Medicine, both in Washington, D.C.