The Predictors of Effectiveness on Urokinase Instillation Therapy into Loculated Pleural Effusion

Song, Kee San; Bang, Jei So; Kwak, Seung Min; Cho, Chul Ho; Park, Chan Sup

Abstract

BACKGROUND
As the pleural inflammation progresses, exudative pleural fluid becomes loculated rapidly with pleural thickening. Complete drainage is important 13 prevent pleural fibrosis, entrapment and depression of lung function Intrapleural urokinase instillation therapy has been advocated as a method to facilitate drainage of gelatinous pleural fluid and to allow enzymatic debriment of pleural surface. This study was designed to investigate the Predictors of effeotiveness of intrapleural urokinase in treatment of loculated pleural effusion METHOD: Thirty-five patients received a single radiographically guided pig-tail catheter ranging in size from 10 to 12 French Twenty-two patients had tuberculous pleural effusions, and 13 had non-tuberculous postpneumonic empyemas. A total of 240,000 units of urokinase was dissolved in 240 ml of normal saline and the aliquots of 80mL was instilled into the pleura1 cavity via pig-tail catheter per every 8hr. Effectiveness of intrapleural urokinase instillation therapy was assessed by biochemical markers, ultrasonography, and technical details. A greater than 50% improvement on follow-up chest radiographs was defined as success group. RESULT: Twenty-seven of 35 (77.1%) patients had successful outcome to urokinase instillation therapy. Duration of symptoms before admission was shorter in sucess group (11.8Î±6.9day) than in failure group (26.62Î±16.5day) (P<0.05). Amount of drained fluid during urokinsse therapy was larger in success group (917.1Î±392.7ml) than in failure group (613.8Î±259.7ml) (P<0.05). Pleural fluid glucose was higher in success group (89.7 Î±35.9mg/dl) than in failure group (41.2Î±47.1mg/dl) (P<0.05). Pleural fluid LDH was lower in success group (878.4Î±654.31U/L) than in failure group (2711.1Î±973.1IU/L) (P<0.05). Honeycomb septated pattern on chest ultrasonography was observed in six of eight failure group, but none of success group(P<0.05).
CONCLUSION
Longer duration of symptoms before admission smaller amount of drained fluid during urokinase therapy, lower glucose value, higher LDH value in pleural fluid examination and honeycomb septation pattern on chest ultrasonography were predictors for failure group of intrapleural urokinase instillation therapy.