PROMISE Score for Malignant Pleural Effusion Prognosis
Prognostic score for patients with malignant pleural effusion (MPE). Predicts 3-month mortality. Based on LENT score variables plus Performance status. Score 0-7: score 0-1 = low risk (median survival above 12 months); 2-4 = intermediate; 5-7 = high risk (median survival 2 months). Helps guide intervention choices (indwelling pleural catheter vs talc pleurodesis). From Bibby et al. 2018.
Score interpretation
PROMISE 0-1 -- low risk MPE; longer expected survival
→ Talc pleurodesis (chemical pleurodesis) is appropriate if lung fully re-expands after drainage (CTPA/USS to confirm); video-assisted thoracoscopic surgery (VATS) talc poudrage preferred over slurry for best pleurodesis success; discuss with thoracics if VATS indicated; if lung trapped: indwelling pleural catheter (IPC) preferred (PleurX or Rocket); patient-managed drainage at home; oncology review for systemic therapy; close respiratory outpatient follow-up; good prognosis group may benefit from oncology treatment improving effusion control.
PROMISE 2-3 -- intermediate risk MPE; individualised decision required
→ Discussion with patient about intervention goals: symptom palliation vs life expectancy; IPC preferred for patients with intermediate prognosis (avoids repeat hospital admissions); talc pleurodesis if patient able to tolerate procedure and lung expandable; community nursing support for IPC management; oncology involvement for systemic therapy; symptom control: breathlessness, pain management; BSG/BTS pleural disease guidelines consultation; document goals of care; palliative care involvement if symptomatic.
PROMISE 4-5 -- high risk MPE; median survival approximately 2 months; palliation priority
→ Indwelling pleural catheter (IPC) strongly preferred -- minimal procedure burden, immediate drainage, no hospital readmission; avoid aggressive interventions (VATS, talc pleurodesis) given limited prognosis; palliative care involvement for symptom management; community IPC management (district nursing); goals of care discussion with patient and family; DNACPR if appropriate; community palliative care team referral; ensure patient has adequate analgesia for breathlessness (opioids for dyspnoea, benzodiazepines if anxiety); avoid unnecessary investigations; document ceiling of treatment.
Interpretation bands for the PROMISE Score. Apply clinical judgement and local guidance.
References
- Bibby AC et al. The PROMISE grading system: a new tool for assessing clinical outcomes and survival in malignant pleural mesothelioma. BMJ Open. 2018;8(9):e021341.
- Roberts ME et al. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2023. Thorax. 2023;78(Suppl 3):s19-s44.
Related
Curated clinical cross-links plus same-class fallbacks.
- Methotrexate (Dermatology — Psoriasis) · Disease-Modifying Antirheumatic / Immunosuppressant
- Acetazolamide (Ménière's Disease) · Carbonic Anhydrase Inhibitor (Diuretic)
- Zinc acetate · Zinc salt (Wilson's disease)
- Sulfasalazine · Aminosalicylate / Disease-Modifying Antirheumatic Drug (DMARD)
- Hydroxycarbamide (Hydroxyurea) · Cytoreductive agent / Sickle cell disease / CML
- Hydroxycarbamide (Hydroxyurea) · Cytotoxic / Disease-Modifying Agent
- Acute Asthma in Adults · BTS/SIGN British Guideline on Asthma 2019; NICE NG80
- Pulmonary Embolism Assessment · NICE NG158; ESC 2019 PE Guidelines
- Acute Exacerbation of COPD (AECOPD) · NICE NG115; GOLD 2024
- Spontaneous Pneumothorax (Adult) · BTS Pleural Disease 2023
- Atypical Pneumonia (Legionella / Mycoplasma / Chlamydophila) · BTS 2023; IDSA
- COPD Exacerbation Management · NICE NG115 / GOLD 2024
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.