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

Mishra, Eleanor K. ORCID: https://orcid.org/0000-0002-5903-3005, Davies, Helen, Abbas, Syed Hamza, Hardy, Cheryl, Beith, Dominic T., Sethi, Dheeraj, Sapkal, Toshit, Elsheikh, Alguili, Yousuf, Asfandyar, Hedley, Emma L., Daly, Ellie, Sundaralingam, Anand, Addala, Dinesh, Jones, Samantha A., Castle, Lianne, Patel, Neena, Herre, Jurgen, Collins, Hannah, Kastelik, Jack, Ross, Clare L., Corcoran, John, Daneshvar, Cyrus, Shiham, Fathimath, Hufton, Alison, Lynch, Geraldine A., Dipper, Alex, Barton, Eleanor, Clive, Amelia O., Maskell, Nicholas A., Clark, Allan B. ORCID: https://orcid.org/0000-0003-2965-8941 and Rahman, Najib M. (2026) Time to next procedure in patients with malignant pleural effusion undergoing aspiration: derivation and initial validation of the RED score. Thorax, 81 (10). ISSN 0040-6376

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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.

Item Type:	Article
Additional Information:	Data availability statement: Data are available upon reasonable request. Deidentified participant data and data dictionary will be available to researchers following publication on reasonable request by contacting the corresponding author
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School Faculty of Medicine and Health Sciences > School of Health Sciences
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Respiratory and Airways Group Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health Faculty of Science > Research Groups > Statistics Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Centres > Public Health
Related URLs:	https://doi.org/10.1136/thorax-2025-2233...
Depositing User:	LivePure Connector
Date Deposited:	02 Oct 2026 15:33
Last Modified:	02 Oct 2026 19:01
URI:	https://ueaeprints.uea.ac.uk/id/eprint/104712
DOI:	10.1136/thorax-2025-223307

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