Breathlessness present at baseline was found to be associated with shorter survival among patients with malignant pleural effusions (MPEs), according to the results of a meta-analysis published in Chest.

Breathlessness in cardiac diseases and other chronic respiratory diseases has been associated with poor survival. The aim of this study was to determine if breathlessness is also associated with shorter survival in MPE.

The meta-analysis included data from 5 randomized controlled trials of 533 patients with MPE. The visual analogue scale for dyspnea (VASD) was used to determine breathlessness at baseline and at subsequent time points.  The VASD is a 100-mm line ranging from “no breathlessness” to “maximum possible breathlessness,” with increasingly breathlessness represented by higher scores.

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At baseline, the mean VASD was 45.9 mm, with 22% of patients with MPEs having a VASD less than 19 mm.

In a multivariate analysis, baseline VASD of 67 to 100 mm was significantly associated with shorter survival compared with baseline levels of 0 to 33 mm (hazard ratio [HR], 1.73; 95% CI, 1.17-2.54; P =.006). Survival was also associated with 7-day (HR, 1.14; 95% CI, 1.06-1.23) and 84-day VASD (HR, 1.19; 95% CI, 1.04-1.37). 

Compared with patients with mesothelioma, patients with the following factors had worse survival: a 10-unit increase in C-reactive protein (HR, 1.06; 95% CI, 1.03-1.08; P <.001), lung tumors (HR, 2.13; 95% CI, 1.36-3.31), and other tumors (HR, 2.28; 95% CI, 1.43-3.63; P =.001).

The authors concluded that these “data demonstrate that breathless patients with MPE have a worse survival compared to those who are not breathless.”


Mishra EK, Muruganandan S, Clark A, et al. Breathlessness predicts survival in patients with malignant pleural effusions: meta-analysis of individual patient data from five randomized controlled trials. Chest. Published online March 2, 2021. doi:10.1016/j.chest.2021.02.052