These two authors contributed equally to this work.
Efficacy of intrapleural instillation of fibrinolytics for treating pleural empyema and parapneumonic effusion: a meta-analysis of randomized control trials
Version of Record online: 16 JAN 2014
© 2013 John Wiley & Sons Ltd
The Clinical Respiratory Journal
Volume 8, Issue 3, pages 281–291, July 2014
How to Cite
Nie, W., Liu, Y., Ye, J., Shi, L., Shao, F., Ying, K. and Zhang, R. (2014), Efficacy of intrapleural instillation of fibrinolytics for treating pleural empyema and parapneumonic effusion: a meta-analysis of randomized control trials. The Clinical Respiratory Journal, 8: 281–291. doi: 10.1111/crj.12068
Authorship and contributorship
Wencheng Nie wrote the paper. Yanru Liu, Jian Ye and Liuhong Shi revised the paper. Fangchun Shao collected and analyzed data. Kejing Ying designed research. Ruifeng Zhang designed research and analyzed data.
Conflict of interest
The authors have stated explicitly that there are no conflicts of interest in connection with this article.
- Issue online: 2 JUL 2014
- Version of Record online: 16 JAN 2014
- Accepted manuscript online: 29 OCT 2013 04:52AM EST
- Manuscript Accepted: 24 OCT 2013
- Manuscript Revised: 26 SEP 2013
- Manuscript Received: 3 FEB 2013
- National Natural Science Foundation of China. Grant Number: 81000019
- Ministry of Health of Zhejiang Province in China. Grant Number: 2013KYB158
- fibrinolytic ;
- intrapleural ;
- meta-analysis ;
- parapneumonic effusion ;
- pleural empyema
The effects of intrapleural fibrinolysis for treating pleural empyema and parapneumonic effusion remain uncertain.
We conducted a meta-analysis of published randomized controlled trials (RCTs) to evaluate the efficacy of intrapleural instillation of fibrinolytics for treating pleural empyema and parapneumonic effusion.
Medline, Web of Science, Ovid and regulatory documents up to June 10, 2012 were searched. We selected RCTs on intrapleural fibrinolysis vs placebo control treatment for pleural empyema and parapneumonic effusion. The meta-analysis was used to determine the odds ratios (OR) for death, surgical intervention and severe side effects, and weighted mean differences were used to estimate lengths of hospital stays.
Ten trials with a total of 977 patients were included. Compared with a placebo, intrapleural fibrinolytic therapy decreased the OR for surgical intervention [OR = 0.24; 95% confidence interval (CI): 0.10–0.60] and the length of hospital stays (weighted mean difference = −6.47; 95% CI: −8.87, −4.08). Intrapleural fibrinolysis was associated with a non-significant reduction in mortality rate (OR = 1.16; 95% CI: 0.71–1.89) and a non-significant increase in severe side effects (OR = 1.92; 95% CI: 0.87–4.21). Subgroup analyses indicated that urokinase agents had marked positive effects on reducing surgical intervention (OR = 0.33; 95% CI: 0.14–0.78), but neither streptokinase nor tissue plasminogen activator did.
The present results show that intrapleural fibrinolysis with urokinase may be potentially effective for reducing the need for surgery. Intrapleural fibrinolytic therapy is effective for shortening the lengths of hospital stays without increasing the incidence of severe side effects.