The following is a summary of “Pericardial Fluid Analysis in Diagnosis and Prognosis of Patients Who Underwent Pericardiocentesis,” published in the July 2023 issue of the Cardiovascular Disease by Sullivan et al.
In this study, researcher’s objective was to investigate the diagnostic yield of pericardial fluid biochemistry and cytology and their prognostic significance in patients with percutaneously drained pericardial effusions, both with and without malignancy. This study is a retrospective analysis conducted at a single medical facility, focusing on patients who underwent pericardiocentesis procedures from 2010 to 2020. Data were extracted from electronic medical records, encompassing procedural details, underlying medical conditions, and laboratory findings. Patients were categorized based on the presence or absence of an underlying malignancy. A Cox proportional hazards model examined the correlation between variables and mortality.
The study involved a total of 179 patients, with 50% of them having an underlying malignancy. The two cohorts had no notable disparities in pericardial fluid protein and lactate dehydrogenase levels. The diagnostic yield obtained from the pericardial fluid analysis was higher in the group of patients with malignancies (32% compared to 11%, P = 0.002). Additionally, 72% of newly diagnosed malignancies showed positive results in fluid cytology. The 1-year survival rate was 86% and 33% in the nonmalignant and malignant cohorts, respectively (P <0.001). Among the nonmalignant group, the largest subgroup of deceased patients consisted of idiopathic effusions, comprising 6 individuals.
In the context of malignancy, a decrease in pericardial fluid protein levels and an increase in serum C-reactive protein levels were found to be correlated with a heightened risk of mortality. In summary, the biochemistry of pericardial fluid has limited clinical significance in establishing the cause of pericardial effusions. The most crucial diagnostic examination is fluid cytology. Mortality in malignant pericardial effusions may be linked to decreased protein levels in the pericardial fluid and elevated levels of C-reactive protein in the serum. Nonmalignant pericardial effusions exhibit a non-malignant clinical course and necessitate diligent monitoring.