LENT Prognostic Score for Malignant Pleural Effusion
Predicts survival in patients with malignant pleural effusion.
- Use the lactate dehydrogenase (LDH) level from pleural fluid collected during the initial diagnostic or therapeutic thoracentesis.
- Use the blood count closest to the pleural procedure to determine neutrophil-to-lymphocyte ratio.
- Use Eastern Cooperative Oncology Group (ECOG) Performance Status at the time of effusion assessment.
Advice
- Consider prioritizing supportive care and less invasive interventions in patients with higher predicted mortality to improve quality of life.
- Consider symptomatic treatment with an indwelling pleural catheter, with or without chemical pleurodesis, in patients who are low-risk.
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 profiles prior to procedures such as indwelling pleural catheter placement to reduce procedural bleeding risk.
- Confirm lung expandability before attempting pleurodesis.
- Screen for actionable mutations that may qualify patients for targeted treatment, which may improve survival beyond the baseline LENT score.
- Monitor for secondary pleural infections.