Etiologies, fluid characteristics, and outcomes of pericardiocentesis: a five-year retrospective study from a single center

Introduction:
Despite its importance, comprehensive contemporary data on pericardiocentesis (PC) outcomes, etiologies, and prognostic indicators remain limited.

Aim:
We aimed to evaluate the etiologies, pericardial fluid characteristics, and in-hospital and total mortality rates in patients who underwent PC in our center. Additionally, we sought to identify factors associated with total mortality.

Material and methods:
We conducted a single-center retrospective study that included patients who underwent PC performed with the fluoroscopy-guided subxiphoid approach in the catheterization laboratory in our center between November 2019 and November 2024. The patients were classified into two groups: survivors and non-survivors.

Results:
A total of 127 patients were included in this study. The median follow-up was 16 months. In-hospital mortality occurred in 27 (21.3%) patients, and total mortality occurred in 56 (44.1%) patients during follow-up. The most common etiology was malignancy, accounting for 34.6%, followed by idiopathic causes (33.9%). Malignant etiology, presentation with pericardial tamponade, and low albumin levels were found to be independent predictors of mortality (p < 0.001, p = 0.007, p = 0.026, respectively). Malignant pericardial effusion (PE) had a worse prognosis according to the Kaplan-Meier survival curve analysis (log-rank p < 0.001).

Conclusions:
Understanding etiologies is crucial for the prognosis and management of PE. Malignant PE had a worse prognosis compared with non-malignant PE. Therefore, in addition to cytological analysis of the pericardial fluid, the use of advanced imaging methods plays a pivotal role in the evaluation of malignancy, especially in patients without a known malignancy, as PE may be the first sign of cancer.