{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T05:03:30Z","timestamp":1784351010656,"version":"3.55.0"},"reference-count":27,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This study aimed to identify predictors for developing a death rattle in patients with advanced cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>This is a secondary analysis of a multicenter prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/Subjects:<\/jats:title>\n                    <jats:p>We enrolled 1633 patients with advanced cancer admitted to 23 palliative care units throughout Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>We examined associations between patient characteristics, comorbidities, and treatments and the development of a death rattle (Back score \u22652) when Palliative Performance Scale scores dropped to 20 or less using logistic regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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 \u2265200 mL\/day when the performance status score was \u226420 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Volume overload, dysphagia, and factors related to sputum production were identified as predictors for death rattle development in terminally ill patients with cancer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10966218251376430","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T15:20:26Z","timestamp":1757604026000},"page":"1317-1324","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of Death Rattle Development in Patients with Advanced Cancer: A Multicenter Prospective Cohort Study"],"prefix":"10.1177","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3060-0245","authenticated-orcid":false,"given":"Takashi","family":"Yamaguchi","sequence":"first","affiliation":[{"name":"Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan."},{"name":"Department of Palliative Care, Konan Medical Center, Kobe, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0863-1184","authenticated-orcid":false,"given":"Naosuke","family":"Yokomichi","sequence":"additional","affiliation":[{"name":"Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriette Johanna","family":"van Esch","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology and Department of Public Health, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isseki","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Palliative Care, Senri Chuo Hospital, Suita, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Matsunuma","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9797-3487","authenticated-orcid":false,"given":"Yutaka","family":"Hatano","sequence":"additional","affiliation":[{"name":"Department of Palliative Care, Yoshida Hospital, Nara, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukako","family":"Tanaka-Yagi","sequence":"additional","affiliation":[{"name":"Department of Palliative Care, Konan Medical Center, Kobe, 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