Biochemical PROMISE Score for Patient with Malignant Pleural Effusion

Description

Psallidas et al reported 2 scores for the PROMISE study, one clinical and one biochemical. Both can stratify patients with a malignant pleural effusion. The authors are from multiple institutions in Europe, Russia and the United States.

Patient selection: malignant pleural effusion

Outcome: 3-month mortality

Differences between the clinical and biological scores:

(1) tissue inhibitor of metalloproteinase 1 (TIMP1)

(2) different weightings for the other parameters

Parameters for the biochemical score:

(1) chemotherapy

(2) radiotherapy

(3) hemoglobin in g/dL

(4) white blood cell count in 10^9/L

(5) C-reactive protein in nmol/L

(6) ECOG performance status

(7) cancer type

(8) TIMP1 in ng per mg protein

Parameter	Finding	Points
chemotherapy	no	0
	yes	3
radiotherapy	no	0
	yes	2
hemoglobin	> 16 g/dL	0
	14 to 16	1
	12 to 14	2
	10 to 12	3
	< 10 g/dL	4
WBC count	< 4 * 10^9/L	0
	4 to 6.3	2
	6.3 to 10	4
	10 to 15.8	7
	> 15.8 * 10^9/L	9
C-reactive protein	< 3 nmol/L	0
	3 to 10	3
	10 to 32	5
	32 to 100	8
	> 100	10
ECOG performance	0 or 1	0
	2 to 4	7
cancer type	mesothelioma	0
	lung	6
	other	5
TIMP1	< 40 ng per mg protein	0
	40 to 160	1
	> 160	2

where:

• The apparent SIU for CRP is nmol/L. 1 nmol/L = 0.105 mg/L if the molecular weight is taken as 105,000 Daltons. However, higher molecular weights (up to 144,000) are given.

total score =

= SUM(points for all 8 parameters)

Interpretation:

• minimum score: 0

• maximum score: 43

• The higher the score the worse the prognosis.

Clinical Score	Group	3-Month Mortality
0 to 20	A	< 25%
21 to 28	B	25 to 49.9%
29 to 37	C	50 to 74.9%
38 to 43	D	75 to 100%

Score	Absolute Risk
0	2.2
1	2.5
2	2.8
3	3.2
4	3.7
5	4.1
6	4.7
7	5.3
8	6
9	6.8
10	7.7
11	8.7
12	9.8
13	11
14	12.3
15	13.8
16	15.5
17	17.3
18	19.2
19	21.4
20	23.6
21	26.1
22	28.7
23	31.5
24	34.4
25	37.4
26	40.5
27	43.7
28	46.9
29	50.2
30	53.5
31	56.7
32	59.9
33	63
34	66
35	68.9
36	71.6
37	74.2
38	76.7
39	78.9
40	81
41	83
42	> 83
43	> 83

from the Appendix

Performance:

• The area under the ROC curve was 0.81.

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Description

Specialty

Objective

ICD-10

Biochemical PROMISE Score for Patient with Malignant Pleural Effusion

Purpose: To evaluate a patient with a malignant pleural effusion the biochemical PROMISE score.

Description

Specialty

Objective

ICD-10