PROMISE Model 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 clinical score:

(1) chemotherapy

(2) radiotherapy

(3) hemoglobin in g/dL

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

(5) C-reactive protein nmol/L

(6) ECOG performance status

(7) cancer type

Parameter	Finding	Points
chemotherapy	no	0
	yes	4
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	10
C-reactive protein	< 3 nmol/L	0
	3 to 10	3
	10 to 32	5
	32 to 100	8
	> 100	11
ECOG performance	0 or 1	0
	2 to 4	7
cancer type	mesothelioma	0
	lung	5
	other	4

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 7 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 27	B	25 to 49.9%
28 to 35	C	50 to 74.9%
36 to 43	D	75 to 100%

Score	Absolute Risk
0	1.9
1	2.2
2	2.5
3	2.9
4	3.3
5	3.8
6	4.4
7	5
8	5.7
9	6.5
10	7.5
11	8.5
12	9.7
13	11
14	12.4
15	14
16	15.8
17	17.8
18	20
19	22.3
20	24.9
21	27.6
22	30.5
23	33.6
24	36.8
25	40.1
26	43.5
27	47
28	50.6
29	54.1
30	57.6
31	61
32	64.3
33	67.4
34	70.5
35	73.3
36	76
37	78.5
38	80.7
39	82.8
40	84.8
41	86.5
42	88.1
43	89.5

from the Appendix

Performance:

• The area under the ROC curve was 0.78.

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Description

Specialty

Objective

ICD-10

PROMISE Model for Patient with Malignant Pleural Effusion

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

Description

Specialty

Objective

ICD-10