Breathlessness predicts survival in patients with malignant pleural effusions: Meta-analysis of individual patient data from five randomized controlled trials

Eleanor K Mishra, Sanjeevan Muruganandan, Allan Clark, Rahul Bhatnagar, Nick Maskell, Y C Gary Lee, Najib M Rahman

Research output: Contribution to journalArticle (Academic Journal)peer-review

2 Citations (Scopus)
7 Downloads (Pure)


BACKGROUND: Patients with malignant pleural effusions (MPEs) experience breathlessness and poor survival. Breathlessness is associated with poor survival in other conditions.

RESEARCH QUESTION: Is breathlessness, measured using a visual analogue scale for dyspnoea (VASD), associated with survival in patients with MPE?

STUDY DESIGN AND METHODS: Individual patient data from five randomized controlled trials of 553 patients undergoing interventions for MPE were analysed. VASD was recorded at baseline and daily post-intervention. Patients were followed up until death or end of trial. Univariate and multivariable Cox-regression were used to identify factors associated with survival.

RESULTS: Baseline VASD was significantly associated with worse survival, with a hazard ratio of 1.10 (95% CI 1.06-1.15) for a 10mm increase in VASD. On multivariable regression, it remained a significant predictor of survival. Mean 7 day VASD and mean total VASD were also predictors of survival (mean 7 day VASD, HR 1.26 (95% CI 1.19-1.34), total VASD, HR 1.25 (95% CI 1.15-1.37)). Other predictors of survival were serum C reactive protein level and tumour type. 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.

INTERPRETATION: Breathlessness, measured using VASD at baseline and post-procedure, is a predictor of survival in patients with MPE.

Original languageEnglish
Pages (from-to)351-357
Number of pages7
Issue number1
Early online date2 Mar 2021
Publication statusPublished - Jul 2021

Bibliographical note

Funding Information:
Author contributions: E. K. M. is the guarantor of the content of the manuscript, including the data and analysis. E. K. M. had access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. A. C. performed the statistical analysis. All authors contributed substantially to the study design, data interpretation, and the writing of the manuscript. No funding was required for this study. Financial/nonfinancial disclosures: None declared. FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Publisher Copyright:
© 2021 American College of Chest Physicians


  • survival
  • malignant pleural effusion
  • breathlessness


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