Demographic and clinical indicators distinguishing malignant from benign pleural effusion in black patients

Abstract

Background: Pleural effusion is a frequent clinical condition with causes ranging from benign disease to advanced malignancies. Early distinction between malignant pleural effusion (MPE) and benign pleural effusion (BPE) is crucial for diagnosis and management. Data on predictors of MPE in Black populations remain limited despite distinct regional epidemiological patterns. The objective of the study was to describe demographic, clinical features and predictors that differentiate MPE from BPE in black adults.

Materials and Methods: A retrospective descriptive study was conducted at a tertiary care health facility, reviewing records of Black adults aged 18 years and above with confirmed pleural effusion between 2020 and 2025. Patients were classified as having MPE or BPE based on clinical, radiological, cytological and/or histopathological findings. Demographic data, symptoms, clinical findings, imaging characteristics, and pleural fluid features were analysed, and multivariate logistic regression was used to identify independent predictors of MPE.

Results: Eighty-seven patients were included; 25 (28.7%) had MPE and 62 (71.3%) had BPE. Mean age did not differ significantly between groups (46.2 ± 19.3 vs 47.1 ± 19.1 years; P = 0.763). Female sex was more common in MPE (76.0%, P = 0.016). Chest pain (76.0% vs 6.5%, P < 0.001), dyspnoea (64.0% vs 22.6%, P < 0.0006) and weight loss (76.0% vs 6.5%, P < 0.001) showed the strongest associations with MPE. In adjusted analysis, chest pain (adjusted odds ratio [aOR]: 26.85) and weight loss (aOR: 12.47) were dominant predictors.

Conclusions: These findings highlight clinical features that may support earlier suspicion of MPE and improve diagnostic decision-making in resource-limited settings.