Dyspnoea can Predict Survival in Patients With Malignant Pleural Effusions
Malignant pleural effusions (MPEs) are common and cause disabling breathlessness. MPEs are associated with poor survival, with a mean prognosis of approximately 6 months. A recent study suggests that breathlessness measured using a visual analogue scale for dyspnoea (VASD)is associated with survival in patients with MPE. The research has been published in the journal CHEST.
In other chronic respiratory and cardiac diseases associated with poor survival and breathlessness, increased breathlessness has been shown to be predictive of poor survival. In patients with idiopathic pulmonary fibrosis, breathlessness assessed using the Medical Research Council chronic dyspnoea score is associated with poor survival. Dr Eleanor K Mishra and his team further conducted a study to investigate whether breathlessness measured using VASD predicts mortality in patients with MPE.
In this meta-analysis, researchers analyzed individual patient data from five randomized controlled trials of 553 patients undergoing interventions for MPE. They recorded VASD at baseline and daily post-intervention and followed up the patients until death or end of the trial. They used univariate and multivariable cox regression to identify factors associated with survival.
Key findings of the study were:
- At baseline, the researchers found that VASD was significantly association with worse survival (hazard ratio of 1.10) for a 10mm increase in VASD.
- Multivariable regression analysis also confirmed the significance of the association between VASD and poor survival outcome.
- They also noted other predictors of survival such as serum C reactive protein level and tumour type.
- They further noted that previous treatment with chemotherapy, performance status, pleural fluid lactate dehydrogenase, serum albumin, haemoglobin, serum neutrophil: lymphocyte ratio and size of effusion were associated with survival on univariate but not multivariable analysis.
The authors concluded, "meta-analysis of individual patient data from five RCTs has demonstrated an association between breathlessness and survival in patients with MPE".
They further added, "Breathlessness, measured using VASD at baseline and post-procedure, is a predictor of survival in patients with Malignant pleural effusions (MPEs)".
For further information:
https://journal.chestnet.org/article/S0012-3692(21)00452-9/pdf
