Time to next procedure in patients with malignant pleural effusion undergoing aspiration: derivation and initial validation of the RED score

Eleanor K Mishra; Helen Davies; Syed Hamza Abbas; Cheryl Hardy; Dominic T Beith; Dheeraj Sethi; Toshit Sapkal; Alguili Elsheikh; Asfandyar Yousuf; Emma L Hedley; Ellie Daly; Anand Sundaralingam; Dinesh Addala; Samantha A Jones; Lianne Castle; Neena Patel; Jurgen Herre; Hannah Collins; Jack Kastelik; Clare L Ross; John Corcoran; Cyrus Daneshvar; Fathimath Shiham; Alison Hufton; Geraldine A Lynch; Alex Dipper; Eleanor Barton; Amelia O Clive; Nicholas A Maskell; Allan B Clark; Najib M Rahman

doi:10.1136/thorax-2025-223307

Time to next procedure in patients with malignant pleural effusion undergoing aspiration: derivation and initial validation of the RED score

Eleanor K Mishra^*, Helen Davies, Syed Hamza Abbas, Cheryl Hardy, Dominic T Beith, Dheeraj Sethi, Toshit Sapkal, Alguili Elsheikh, Asfandyar Yousuf, Emma L Hedley, Ellie Daly, Anand Sundaralingam, Dinesh Addala, Samantha A Jones, Lianne Castle, Neena Patel, Jurgen Herre, Hannah Collins, Jack Kastelik, Clare L RossJohn Corcoran, Cyrus Daneshvar, Fathimath Shiham, Alison Hufton, Geraldine A Lynch, Alex Dipper, Eleanor Barton, Amelia O Clive, Nicholas A Maskell, Allan B Clark, Najib M Rahman

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

Introduction:
In patients with malignant pleural effusions (MPE), pleural fluid reaccumulates at variable rates following therapeutic aspiration. The aim of this study was to identify variables which predict time to next procedure and use them to develop a predictive score.

Methods:
This prospective observational cohort study in 10 British hospitals recruited patients with known or suspected malignant effusions undergoing therapeutic aspiration. Follow-up lasted 3 months and assessed time to next clinically indicated pleural procedure. Regression analysis was performed to identify independent variables predicting time to next procedure, and a score derived. Initial validation was done in two external cohorts.

Measurements and main results:
241 patients were recruited. Within the derivation cohort (n=180), baseline respiratory rate (R), pleural effusion depth on ultrasound (E) and dyspnoea measured using a visual analogue scale (D) (combined to form the RED score) were independent predictors of time to next procedure. Predictive models provided areas under the receiver operator curve of 0.73 and 0.75. Initial validity testing in two cohorts (n=31, n=57) demonstrated reasonable predictive value.

Conclusions:
In patients with MPE, baseline respiratory rate, pleural effusion depth on ultrasound and dyspnoea predict time to next procedure.

Trial registration number:
ISRCTN16567838.

Original language	English
Article number	thorax-2025-223307
Number of pages	9
Journal	Thorax
Early online date	28 Jan 2026
DOIs	https://doi.org/10.1136/thorax-2025-223307
Publication status	E-pub ahead of print - 28 Jan 2026

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2026.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Pleural Disease
Lung Cancer
Mesothelioma

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Mishra, E. K., Davies, H., Abbas, S. H., Hardy, C., Beith, D. T., Sethi, D., Sapkal, T., Elsheikh, A., Yousuf, A., Hedley, E. L., Daly, E., Sundaralingam, A., Addala, D., Jones, S. A., Castle, L., Patel, N., Herre, J., Collins, H., Kastelik, J., ... Rahman, N. M. (2026). Time to next procedure in patients with malignant pleural effusion undergoing aspiration: derivation and initial validation of the RED score. Thorax, Article thorax-2025-223307. Advance online publication. https://doi.org/10.1136/thorax-2025-223307

@article{2748dee5822343ca8bafd5e3095c8b63,

title = "Time to next procedure in patients with malignant pleural effusion undergoing aspiration: derivation and initial validation of the RED score",

abstract = "Introduction: In patients with malignant pleural effusions (MPE), pleural fluid reaccumulates at variable rates following therapeutic aspiration. The aim of this study was to identify variables which predict time to next procedure and use them to develop a predictive score. Methods: This prospective observational cohort study in 10 British hospitals recruited patients with known or suspected malignant effusions undergoing therapeutic aspiration. Follow-up lasted 3 months and assessed time to next clinically indicated pleural procedure. Regression analysis was performed to identify independent variables predicting time to next procedure, and a score derived. Initial validation was done in two external cohorts. Measurements and main results: 241 patients were recruited. Within the derivation cohort (n=180), baseline respiratory rate (R), pleural effusion depth on ultrasound (E) and dyspnoea measured using a visual analogue scale (D) (combined to form the RED score) were independent predictors of time to next procedure. Predictive models provided areas under the receiver operator curve of 0.73 and 0.75. Initial validity testing in two cohorts (n=31, n=57) demonstrated reasonable predictive value. Conclusions: In patients with MPE, baseline respiratory rate, pleural effusion depth on ultrasound and dyspnoea predict time to next procedure. Trial registration number: ISRCTN16567838.",

keywords = "Pleural Disease, Lung Cancer, Mesothelioma",

author = "Mishra, \{Eleanor K\} and Helen Davies and Abbas, \{Syed Hamza\} and Cheryl Hardy and Beith, \{Dominic T\} and Dheeraj Sethi and Toshit Sapkal and Alguili Elsheikh and Asfandyar Yousuf and Hedley, \{Emma L\} and Ellie Daly and Anand Sundaralingam and Dinesh Addala and Jones, \{Samantha A\} and Lianne Castle and Neena Patel and Jurgen Herre and Hannah Collins and Jack Kastelik and Ross, \{Clare L\} and John Corcoran and Cyrus Daneshvar and Fathimath Shiham and Alison Hufton and Lynch, \{Geraldine A\} and Alex Dipper and Eleanor Barton and Clive, \{Amelia O\} and Maskell, \{Nicholas A\} and Clark, \{Allan B\} and Rahman, \{Najib M\}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2026.",

year = "2026",

month = jan,

day = "28",

doi = "10.1136/thorax-2025-223307",

language = "English",

journal = "Thorax",

issn = "0040-6376",

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Mishra, EK, Davies, H, Abbas, SH, Hardy, C, Beith, DT, Sethi, D, Sapkal, T, Elsheikh, A, Yousuf, A, Hedley, EL, Daly, E, Sundaralingam, A, Addala, D, Jones, SA, Castle, L, Patel, N, Herre, J, Collins, H, Kastelik, J, Ross, CL, Corcoran, J, Daneshvar, C, Shiham, F, Hufton, A, Lynch, GA, Dipper, A, Barton, E, Clive, AO, Maskell, NA, Clark, AB & Rahman, NM 2026, 'Time to next procedure in patients with malignant pleural effusion undergoing aspiration: derivation and initial validation of the RED score', Thorax. https://doi.org/10.1136/thorax-2025-223307

TY - JOUR

T1 - Time to next procedure in patients with malignant pleural effusion undergoing aspiration

T2 - derivation and initial validation of the RED score

AU - Mishra, Eleanor K

AU - Davies, Helen

AU - Abbas, Syed Hamza

AU - Hardy, Cheryl

AU - Beith, Dominic T

AU - Sethi, Dheeraj

AU - Sapkal, Toshit

AU - Elsheikh, Alguili

AU - Yousuf, Asfandyar

AU - Hedley, Emma L

AU - Daly, Ellie

AU - Sundaralingam, Anand

AU - Addala, Dinesh

AU - Jones, Samantha A

AU - Castle, Lianne

AU - Patel, Neena

AU - Herre, Jurgen

AU - Collins, Hannah

AU - Kastelik, Jack

AU - Ross, Clare L

AU - Corcoran, John

AU - Daneshvar, Cyrus

AU - Shiham, Fathimath

AU - Hufton, Alison

AU - Lynch, Geraldine A

AU - Dipper, Alex

AU - Barton, Eleanor

AU - Clive, Amelia O

AU - Maskell, Nicholas A

AU - Clark, Allan B

AU - Rahman, Najib M

PY - 2026/1/28

Y1 - 2026/1/28

N2 - Introduction: In patients with malignant pleural effusions (MPE), pleural fluid reaccumulates at variable rates following therapeutic aspiration. The aim of this study was to identify variables which predict time to next procedure and use them to develop a predictive score. Methods: This prospective observational cohort study in 10 British hospitals recruited patients with known or suspected malignant effusions undergoing therapeutic aspiration. Follow-up lasted 3 months and assessed time to next clinically indicated pleural procedure. Regression analysis was performed to identify independent variables predicting time to next procedure, and a score derived. Initial validation was done in two external cohorts. Measurements and main results: 241 patients were recruited. Within the derivation cohort (n=180), baseline respiratory rate (R), pleural effusion depth on ultrasound (E) and dyspnoea measured using a visual analogue scale (D) (combined to form the RED score) were independent predictors of time to next procedure. Predictive models provided areas under the receiver operator curve of 0.73 and 0.75. Initial validity testing in two cohorts (n=31, n=57) demonstrated reasonable predictive value. Conclusions: In patients with MPE, baseline respiratory rate, pleural effusion depth on ultrasound and dyspnoea predict time to next procedure. Trial registration number: ISRCTN16567838.

AB - Introduction: In patients with malignant pleural effusions (MPE), pleural fluid reaccumulates at variable rates following therapeutic aspiration. The aim of this study was to identify variables which predict time to next procedure and use them to develop a predictive score. Methods: This prospective observational cohort study in 10 British hospitals recruited patients with known or suspected malignant effusions undergoing therapeutic aspiration. Follow-up lasted 3 months and assessed time to next clinically indicated pleural procedure. Regression analysis was performed to identify independent variables predicting time to next procedure, and a score derived. Initial validation was done in two external cohorts. Measurements and main results: 241 patients were recruited. Within the derivation cohort (n=180), baseline respiratory rate (R), pleural effusion depth on ultrasound (E) and dyspnoea measured using a visual analogue scale (D) (combined to form the RED score) were independent predictors of time to next procedure. Predictive models provided areas under the receiver operator curve of 0.73 and 0.75. Initial validity testing in two cohorts (n=31, n=57) demonstrated reasonable predictive value. Conclusions: In patients with MPE, baseline respiratory rate, pleural effusion depth on ultrasound and dyspnoea predict time to next procedure. Trial registration number: ISRCTN16567838.

KW - Pleural Disease

KW - Lung Cancer

KW - Mesothelioma

U2 - 10.1136/thorax-2025-223307

DO - 10.1136/thorax-2025-223307

M3 - Article (Academic Journal)

C2 - 41605644

SN - 0040-6376

JO - Thorax

JF - Thorax

M1 - thorax-2025-223307

ER -

Time to next procedure in patients with malignant pleural effusion undergoing aspiration: derivation and initial validation of the RED score

Abstract

Bibliographical note

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Keywords

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