PROMISE Score for Malignant Pleural Effusion
Predicts 3-month mortality in patients with malignant pleural effusion.
- Use the patient's baseline/pre-treatment laboratory values.
- Document Eastern Cooperative Oncology Group (ECOG) Performance Status explicitly rather than estimating it from hospitalization severity.
- Classify the cancer according to the primary tumor responsible for the malignant pleural effusion.
- Record whether chemotherapy or radiotherapy occurred before the PROMISE assessment.
Advice
Results should inform, not dictate, clinical decisions; do not use this tool to dismiss an alternative diagnosis simply because malignancy is suspected.
- Consider prioritizing supportive care and avoiding invasive interventions in patients with higher predicted mortality to improve quality of life.
- Elevated CRP is nonspecific; use clinical judgment and ensure that pleural fluid is carefully evaluated for potential coexisting infectious or inflammatory etiologies.
Management
Consider prognosis when discussing treatment options; patients at high risk with low predicted survival may prefer a permanent indwelling pleural catheter or therapeutic aspiration to minimize hospital stay, rather than attempted pleurodesis.
Critical Actions
- Check baseline coagulation studies before procedures such as indwelling pleural catheter placement to reduce procedural bleeding risk.
- Confirm lung expandability before attempting pleurodesis.
- Exclude potentially reversible or immediately life-threatening causes of pleural effusion, particularly pulmonary embolism, hemothorax, empyema or pleural infection, tension physiology, and acute heart failure when the clinical presentation is atypical or rapidly progressive.
- Assess for pleural infection when clinically appropriate; fever, systemic inflammatory response, purulent fluid, low pleural fluid pH and/or glucose, or loculations should prompt evaluation and management for pleural infection rather than relying on a prognostic score.