Comparing the outcomes of intrapleural fibrinolytic and DNase therapy versus intrapleural fibrinolytic or DNase therapy: A systematic review and meta-analysis. (December 2021)

• Record Type: Journal Article
• Authors: Chong, Woon Hean; Hu, Kurt; Saha, Biplab K.; Chopra, Amit
• Is Part Of: Pulmonary pharmacology & therapeutics. Volume 71(2021)
• Publication Date: 2021-12
• Subjects: Pleural infections -- Parapneumonic effusions -- Empyema -- Intrapleural -- Fibrinolytic -- tPA -- Tissue plasminogen activator -- DNase; Respiratory organs -- Diseases -- Chemotherapy -- Periodicals; 615.7205
• DOI: 10.1016/j.pupt.2021.102081
• Languages: English
• ISSNs: 1094-5539

Abstract

Abstract: Background: Multiple studies describing the benefits of intrapleural fibrinolytic over placebo and DNase therapy have been published, but few have been published on intrapleural fibrinolytic and DNase therapy. Objective: Our meta-analysis aims to compare the outcomes of surgical intervention, mortality, and hospital length of stay between intrapleural fibrinolytic and DNase therapy with either intrapleural fibrinolytic or DNase therapy alone in patients with pleural space infections. Methods: We searched Pubmed, EMBASE, Web of Science, and Cochrane library databases for observational studies and randomized controlled trials (RCTs) containing comparative data for hospitalized adults and children with pleural infections receiving intrapleural therapy of fibrinolytic and DNase versus those receiving intrapleural fibrinolytic or DNase alone. Meta-analysis was performed using the Review Manager software, and heterogeneity was tested using I 2 statistics. Results: A total of 2 cohorts and 2 RCTs involving 362 adult and children was included. There was significant reduction in surgical intervention requirement among patients who received intrapleural fibrinolytic and DNase (OR 0.30; 95% CI 0.11–0.83; I 2 = 31%; P = 0.02) than those receiving either intrapleural fibrinolytic or DNase alone. No difference was observed for mortality (OR 0.72; 95% CI 0.31–1.71; I 2 = 0%; P = 0.46) and complication rates (OR 3.09; 95% CI 0.75–12, 74; I 2 = 54%; P = 0.12). The hospital length of stay (mean 13.70 vs. 16.67 days; P = 0.19) and duration of chest tube drainage (mean 6.47 vs. 6.30 days; P = 0.58) was similar between the two groups. Conclusion: Combination of intrapleural fibrinolytic and DNase, compared to single-agent intrapleural therapy alone, is associated with a lesser need for surgical interventions. However, no difference was found in mortality, hospital length of stay, and chest tube drainage duration. Highlights: Intrapleural fibrinolytic and DNase reduce surgical interventions for pleural space infections than either intrapleural fibrinolytic or DNase alone. Mortality and complication rates were similar when receiving intrapleural combination therapy versus either intrapleural fibrinolytic or DNase alone. No difference was observed for hospital length of stay and duration of chest tube drainage regardless of intrapleural therapy received.