Low pericardial fluid glucose concentration combined with computed tomography evaluation as a malignancy-related marker in symptomatic patients undergoing pericardiocentesis: a retrospective study

Background: We evaluated malignancy according to the characteristics of pericardial fluid in symptomatic Japanese patients undergoing pericardiocentesis and computed tomography (CT).Methods: This was a retrospective, single-center, observational study of 125 symptomatic patients undergoing pericardiocentesis. The patients were classified into two groups: a malignancy group and a non-malignancy group, according to the primary disease and cytology of the pericardial effusion (PE). We compared the pericardial fluid sample and CT measurements between both groups.Results: All patients were diagnosed as having exudative PE by Light’s criteria. PE with malignant cells was demonstrated in 76.8% of the malignancy group patients. A ratio of pericardial to serum lactate dehydrogenase (LDH) >0.6 as one of Light’s criteria, and lower serum brain natriuretic peptide (BNP: 126.9±89.8 pg/ml vs 409.2±97.7 pg/ml, malignancy vs non-malignancy groups, respectively; p = 0.037) were associated with malignancy (both, p < 0.05). A significant difference was observed in pericardial fluid glucose level between the malignancy and non-malignancy groups (pericardial fluid glucose: 78.25±48.29 mg/dl vs 98.41±44.85, respectively; p < 0.05). Moreover, CT attenuation values (Hounsfield units (HU)) tended to be higher in the malignancy group vs the non-malignancy group (22.7 [interquartile range (IQR), 17.4–26.0] vs 17.4 [IQR, 13.7–26.4], respectively; p = 0.08). Pericardial fluid glucose level ≤70 mg/dl and CT attenuation values >20 HU were strongly associated with malignancy.Conclusions: Lower pericardial fluid glucose level with higher CT attenuation values may suggest malignancy-related PE.