1279P Changes in vital signs of end-of-life patients with advanced cancer: A prospective cohort study

Abstract

Changes in vital signs in end-of-life (EOL) cancer patients near impending death are relatively common. However, there are few reports indicate that the timing of death can be predicted by changes in vital signs is unclear. The aim of this study was to clarify the role of changes in vital signs in patients with advanced cancer near impending death. In this pre-planned secondary analysis of a multicenter, prospective East Asian cross-cultural collaborative cohort study in palliative care units (PCU) between January and December 2017 had their vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation, and temperature) documented once a day serially from a palliative performance scale (PPS) of <20 to death. We divided the timeframes into Segment 1 (Seg 1): days 14–3 and Segment 2 (Seg 2): days 2–1 from date of death, and measured changes in vital signs. We calculated respective sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) for death in two days. The 1,221 study patients (633 men, 588 women; median age: 73 years) came from 21 institutions throughout Japan. Average vital signs were 107.45 mmHg in Seg 1 and 95.08 in Seg 2 for systolic blood pressure; 67.51 mmHg in Seg 1 and 61.64 mmHg in Seg 2 for diastolic blood pressure; 97.38 in Seg 1 and 100.55 in Seg 2 for heart rate; 15.32 in Seg 1 and 16.23 in Seg 2 for respiratory rate; 37.06 in Seg 1 and 37.19 in Seg 2 for body temperature; and 94.86 in Seg1 and 93.43 in Seg 2 for oxygen saturation. Systolic blood pressure (p<0.001), diastolic blood pressure (p<0.001), heart rate (p=0.002), respiratory rate (p=0.004), body temperature (p=0.001), and oxygen saturation (p<0.001) varied significantly between Segment 1 and Segment 2. The changes in vital signs to predict impending death were generally characterized by low sensitivity (4.8–51.8%) and high specificity (68.0–96.0%). Vital signs significantly change near impending death in patients with cancer. The changes in vital signs to predict impending death were generally characterized by low sensitivity and high specificity.