PROMISE Score for Malignant Pleural Effusion
PROMISE Calculator
ECOG Performance Status
Blood Neutrophil-to-Lymphocyte Ratio (NLR)
Tumor Type (LENT Classification)
PROMISE Score:
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Predicts 3-month mortality in patients with malignant pleural effusion.
When to Use
Use in patients with late-stage cancer and malignant pleural effusion, either from primary lung cancer or metastasis to lung.
Formula
Addition of the selected points. TIMP1 is required to calculate biological PROMISE Score. Variable Points Clinical PROMISE Score Biological PROMISE Score (with TIMP1) Previous chemotherapy* No 0 0 Yes 4 3 Previous radiotherapy* No 0 0 Yes 2 2 Hemoglobin, g/dL ≥16 0 0 14 to <16 1 1 12 to <14 2 2 10 to <12 3 3 <10 4 4 Serum white blood cell count, 10⁹ cells/L <4 0 0 4 to <6.3 2 2 6.3 to <10 4 4 10 to <15.8 7 7 ≥15.8 10 9 C-reactive protein, IU/L <3 0 0 3 to <10 3 3 10 to <32 5 5 32 to <100 8 8 ≥100 11 10 ECOG performance status 0-1 0 0 2-4 7 7 Cancer type Mesothelioma 0 0 All other types of cancer 4 5 Lung 5 6 TIMP1**, ng/mg protein <40 - 0 40 to <160 - 1 ≥160 - 2 *At any time. **Optional, for calculating Biological PROMISE Score.
Pearls / Pitfalls
TIMP1 is not available at all institutions, but if available, can add to the prognostic power of the score.
Advice
Consider optimizing supportive care and avoiding invasive interventions in patients with higher mortality to improve quality of life. Elevated CRP is nonspecific. Use clinical judgment and ensure that pleural fluid is carefully evaluated for potential coexisting infectious/inflammatory etiologies.
More Information
Interpretation: Clinical PROMISE Score Biological PROMISE Score 3-month mortality 0-20 0-20 <25% 21-27 21-28 25 to <50% 28-35 29-37 50 to <75% >35 >37 ≥75%