Etiological distribution and mortality factors in pericardial effusion: Insights from a large cohort study

Abstract

Background: Pericardial effusion represents a potentially life-threatening clinical entity arising from diverse pathophysiological processes, with etiological prevalence demonstrating substantial geographic and ethnic variation. Despite this recognized heterogeneity, epidemiological data characterizing the distribution of pericardial effusion etiologies in Indian populations remain limited.

Methods: This observational cohort study enrolled 695 consecutive patients presenting with moderate-to-large pericardial effusion at a tertiary cardiac care center. Comprehensive demographic and etiological data were systematically collected, with prospective follow-up extending over a 24-month period.

Results: The 695 patients exhibited a male predominance (55.68%). Etiological analysis revealed tuberculosis as the most frequent cause (32.52%), followed by malignancy (30.6%), idiopathic effusion (19.14%), hypothyroidism (7.77%), chronic kidney disease (5.75%), connective tissue disorders (3.16%), and pyogenic infections (1.0%). Among malignancy- associated effusions, pulmonary carcinoma accounted for 47.41% of cases. In patients presenting with cardiac tamponade, malignancy was identified in 47.12% and tuberculosis in 29.15%. Over the 24-month follow-up period, malignancy was responsible for 78.76% of observed mortality. Kaplan-Meier survival analysis demonstrated that patients with malignancy-associated effusion exhibited the poorest prognosis, followed sequentially by those with chronic kidney disease and tuberculosis.

Conclusion: Tuberculous pericarditis emerged as the predominant etiology of pericardial effusion in this cohort. However, malignancy, particularly pulmonary carcinoma, constituted the principal cause of mortality, followed by chronic kidney disease and tuberculosis. Kaplan- Meier survival analysis underscored the adverse prognostic impact of malignancy-associated pericardial effusion, highlighting the critical importance of prompt diagnostic evaluation and therapeutic intervention.