Clinical Factors Influencing Spontaneous Pleurodesis Success in Malignant Pleural Effusion in Patients with Indwelling Pleural Catheter

Background: Indwelling pleural catheters (IPCs) provide effective palliation for malignant pleural effusion (MPE) and may induce spontaneous pleurodesis (SP). However, concurrent transudative conditions such as hypoalbuminemia, congestive cardiac failure (CCF), and renal failure (RF) may reduce pleurodesis success. Evidence on the impact of these comorbidities in MPE patients undergoing IPC placement remains limited.
Objective: To evaluate the impact of hypoalbuminemia, congestive cardiac failure (CCF) and renal failure (RF) on successful spontaneous pleurodesis in MPE.
Methods: A retrospective single-centre study was conducted in a tertiary care hospital, on all patients with cytologically or radiologically confirmed MPE who underwent IPC placement between January 2020 and December 2024. SP was defined as catheter removal without fluid recurrence for ≥1 month. Demographic data, albumin levels, comorbidities, cancer type, active anti-cancer therapy, were compared between SP and non-pleurodesis (NP) group.
Results: Among 110 patients (mean age 70 years, 49% male), 30 (27%) achieved SP. Mean serum albumin was higher in the SP group (25.2 vs 20.4 g/L, p=0.001). CCF (p=0.005) and RF were more common in NP. Systemic anti-cancer therapy was associated with higher SP (87% vs 40%, p<0.001). SP varied by cancer type, highest in mesothelioma (50%) and absent in small cell lung cancer.
Conclusions: Higher albumin, active anti-cancer therapy, and absence of multiple transudative comorbidities predict successful SP. Identifying these factors may improve patient selection and procedural outcomes.