OPA11 PREDICTORS OF DRAINAGE DURATION AND TRAPPED LUNG IN THORACOSCOPIC BIOPSY-PROVEN PLEURAL TUBERCULOSIS: EARLY INSIGHTS FROM THE SAPTO STUDY

Larry Ellee Nyanti1,2, Nik Azhan Hakim Mohd Fuzi2, Kwong Hui Wong2, Jiun Hang Lee2, Xin Ying Lee3, Ag Zarif, Aminuddin Ag Damit2, Niza Soraya Binti Abdul Patar2, Yee Von Wong2, Yi Lin Tang1, Muhammad Aklil Abd Rahim4, Subramaniam a/l Ponnuvelu2, Meryl Grace Lansing1,2, Nai Chien Huan2, Shan Min Lo2, Hema Yamini Ramarmuty2, Kunji Kannan Sivaraman Kannan2
1Medical Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
2Department of Respiratory Medicine, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia
3Medical Department, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia
4Department of Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia

Introduction

Tuberculous pleural effusion (TPE) manifests with varying degrees of complexities. Predictors of clinical outcomes in TPE remain to be elucidated. 

Objectives

To describe the clinical-radiological, thoracoscopic and biochemical characteristics of TPE and ascertain parameters which predict drainage duration and trapped lung in TPE.

Methodology

The Sabah Pleural Tuberculosis Outcomes (SAPTO) study is a retrospective analysis of biopsy-confirmed TPE between 1st June 2022 to 31st May 2024 in Hospital Queen Elizabeth, Malaysia. Medical records were examined and data extracted and analysed using SPSS version 28 (IBM, Armond, New York, United States).

Results

105 patients were included in the final analysis, with mean ADA of 46.7 (SD=17.5), mean LDH/ADA ratio of 10.1 (SD=6.6). Fibrinolytics were administered in 8.6% of patients. Average number of drainage days was 5.64 days (SD=7.025). 

Simple negative binomial regression showed that fibrinolytic use did not significantly shorten drainage duration. Variables that significantly predicted longer drainage duration included comorbid hypertension (p=0.019, IRR=1.65, 95% CI [1.09,2.51]), diabetes (p=<0.001, IRR=2.35, 95% CI [1.43,3.86]). The only variable that significantly predicted shorter drainage duration was a positive tissue Xpert MTB/RIF (p=0.002, IRR=0.48, 95% CI [0.31,0.76]). When all the significant variables were incorporated into the multivariable model, only tissue Xpert MTB/RIF remained significant. Meanwhile, logistic regression demonstrated that predictors of trapped lung include LDH/ADA ratio (B=0.088, p=0.019, Exp(B)=1.092, 95% CI [1.015,1.175]) and volume of fluid drained in pleuroscopy (B=0.001, p=0.042, Exp(B)=1.001, 95% CI [1.000,1.002]). 

Conclusion

Adhesiolysis may be effective in reducing drainage duration, while the utility of fibrinolytics remains unproven in TPE. Tissue Gene Xpert MTB/RIF may expedite the management of TPE. This study is limited by its retrospective design, inter-operator variability in drain management, and would benefit from a multi-centre prospective evaluation.