Predictors of Death Rattle Development in Patients with Advanced Cancer: A Multicenter Prospective Cohort Study

Background: A death rattle, characterized by noisy breathing due to accumulated secretions, is a common symptom in terminally ill patients with cancer; however, its predictive factors have yet to be fully elucidated. Objectives: This study aimed to identify predictors for developing a death rattle in patients with advanced cancer. Design: This is a secondary analysis of a multicenter prospective cohort study. Setting/Subjects: We enrolled 1633 patients with advanced cancer admitted to 23 palliative care units throughout Japan. Measurements: We examined associations between patient characteristics, comorbidities, and treatments and the development of a death rattle (Back score ≥2) when Palliative Performance Scale scores dropped to 20 or less using logistic regression analysis. Results: A death rattle developed in 196 patients (12.0%). Multivariate analysis revealed that smoking history, cerebrovascular disease/congestive heart failure history, lung metastasis, moderate-to-severe edema on admission, symptomatic pleural effusion, high-dose antipsychotics, and hydration volume ≥200 mL/day when the performance status score was ≤20 was significantly associated with death rattle development. Moderate-to-severe edema and high-dose antipsychotics were predictors for a type 1 rattle (predominantly pharyngeal secretions), whereas smoking history was a predictor for a type 2 rattle (predominantly bronchial secretions). Conclusions: Volume overload, dysphagia, and factors related to sputum production were identified as predictors for death rattle development in terminally ill patients with cancer.