Prognostic Factors in Moderate-to-Large Pericardial Effusion Requiring Pericardiocentesis. A Single-Center Retrospective Study

Aim    Pericardial effusion is relatively common in daily clinical practice. To our knowledge, no study to date has been conducted on any laboratory parameter that predicts mortality in patients presenting with pericardial effusion. The present study evaluated the prognostic factors of patients with moderate to large pericardial effusions requiring pericardiocentesis.
Material and methods    This retrospective study included 156 patients who underwent pericardiocentesis in our hospital between 2013 and 2022.
Results    73 of the patients (46.8 %) survived. Nonsurvivors had hypoalbuminemia more often than survivors (p<0.001). Median follow-up time in non-survivors was 274.5 [4.0–3507.0] days, while median follow-up time in survivors was 1490.0 [109.0–3209.0]. In-hospital mortality was seen in only 8 patients. The median neutrophil / lymphocyte ratio was significantly lower in survivors than nonsurvivors (p=0.005). The ROC curve analysis showed that the neutrophil / lymphocyte ratio was higher than 4.49, with sensitivity and specificity rates of 78.57 % and 51.75 % in predicting mortality (AUC=0.622, 95 % confidence interval: 0.541–0.698, p=0.013).
Conclusions    The present study showed that the neutrophil / lymphocyte ratio and hypoalbuminemia, which are laboratory values at the time of admission, albumin in the pericardial fluid, and malignant pathology all play roles in the prognosis of pericardial effusion requiring pericardiocentesis.

1. Imazio M, Trinchero R. Triage and management of acute pericarditis. International Journal of Cardiology. 2007;118(3):286–94. DOI: 10.1016/j.ijcard.2006.07.100

2. Imazio M, Mayosi BM, Brucato A, Markel G, Trinchero R, Spodick DH et al. Triage and management of pericardial effusion. Journal of Cardiovascular Medicine. 2010;11(12):928–35. DOI: 10.2459/JCM.0b013e32833e5788

3. Imazio M, Adler Y. Management of pericardial effusion. European Heart Journal. 2013;34(16):1186–97. DOI: 10.1093/eurheartj/ehs372

4. Colombo A, Olson HG, Egan J, Gardin JM. Etiology and prognostic implications of a large pericardial effusion in men. Clinical Cardiology. 1988;11(6):389–94. DOI: 10.1002/clc.4960110606

5. Søgaard KK, Farkas DK, Ehrenstein V, Bhaskaran K, Bøtker HE, Sørensen HT. Pericarditis as a Marker of Occult Cancer and a Prognostic Factor for Cancer Mortality. Circulation. 2017;136(11):996–1006. DOI: 10.1161/CIRCULATIONAHA.116.024041

6. Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural Effusions: The Diagnostic Separation of Transudates and Exudates. Annals of Internal Medicine. 1972;77(4):507–13. DOI: 10.7326/0003-4819-77-4-507

7. Buoro S, Tombetti E, Ceriotti F, Simon C, Cugola D, Seghezzi M et al. What is the normal composition of pericardial fluid? Heart. 2021;107(19):1584–90. DOI: 10.1136/heartjnl-2020-317966

8. Küçük U, Gazi E, Kırılmaz B. Roles of the Ratio of C-Reactive Protein to Serum and Pericardial Fluid Albumin Levels in Predicting in-Hospital Mortality in Patients Undergoing Pericardiocentesis. Archives of Current Medical Research. 2021;2(3):146–52

9. Afşin A, Asoğlu R, Kurtoğlu E, Kaya H. Neutrophil to Lymphocyte Ratio as a Predictor of Left Ventricular Hypertrophy in Patients with Newly Diagnosed Hypertension. Journal of Hypertension and Management. 2019;5(2):1–9. DOI: 10.23937/2474-3690/1510042

10. Shahim B, Redfors B, Lindman BR, Chen S, Dahlen T, Nazif T et al. Neutrophil‐to‐Lymphocyte Ratios in Patients Undergoing Aortic Valve Replacement: The PARTNER Trials and Registries. Journal of the American Heart Association. 2022;11(11):e024091. DOI: 10.1161/JAHA.121.024091

11. Adamstein NH, MacFadyen JG, Rose LM, Glynn RJ, Dey AK, Libby P et al. The neutrophil–lymphocyte ratio and incident atherosclerotic events: analyses from five contemporary randomized trials. European Heart Journal. 2021;42(9):896–903. DOI: 10.1093/eurheartj/ehaa1034

12. Cho JH, Cho H-J, Lee H-Y, Ki Y-J, Jeon E-S, Hwang K-K et al. Neutrophil-Lymphocyte Ratio in Patients with Acute Heart Failure Predicts In-Hospital and Long-Term Mortality. Journal of Clinical Medicine. 2020;9(2):557. DOI: 10.3390/jcm9020557