Assessment of the Palliative Prognostic Index in hospitalized oncologic patients treated by a palliative care team: impact of acute concomitant diseases.

Carmen Palomar-Muñoz,Marina Martín-Zamorano,Amparo Mogollo,Inmaculada Rodríguez-Morales,Susana Pascual-Pérez,José-Antonio Girón-González

doi:10.18632/oncotarget.24826

Abstract

The differential prognostic accuracy of the Palliative Prognostic Index (PPI) in hospitalized oncologic patients treated by a palliative care team according to the presence or absence of acute concomitant diseases was analyzed. All patients (n = 322) hospitalized in a palliative unit of a university hospital were included in a 2-year prospective study. PPI was determined at the time of hospital admission and discharge. Patients were grouped into two categories according to the causes of hospitalization (presence and absence of acute concomitant diseases). Metastases, PPI punctuation, refractory symptoms, and the presence of acute concomitant diseases were analyzed as survival-related factors. The absence of acute concomitant diseases and a PPI calculated at admission >4 or >6 were related with survival at 3 and 6 weeks, respectively. After hospital discharge, the accuracy of PPI was lower, decreasing the positive predictive value from 84% (PPI calculated at the time of hospital admission) to 67% (PPI calculated at the time of discharge) for survival <6 weeks. In conclusion, the impact of acute concomitant diseases on survival should be considered in prediction models for patients receiving palliative care.

Highlights

In patients receiving care in palliative care units (PCUs), information about prognosis is important to help patients set priorities and expectations for care and to assist clinicians in decision-making
The differential prognostic accuracy of the Palliative Prognostic Index (PPI) in hospitalized oncologic patients treated by a palliative care team according to the presence or absence of acute concomitant diseases was analyzed
The accuracy of PPI was lower, decreasing the positive predictive value from 84% (PPI calculated at the time of hospital admission) to 67% (PPI calculated at the time of discharge) for survival

Summary

INTRODUCTION

In patients receiving care in palliative care units (PCUs), information about prognosis is important to help patients set priorities and expectations for care and to assist clinicians in decision-making. The Palliative Prognostic Index (PPI) is the sum of the PPS and other clinical variables (oral intake, edema, resting dyspnea, and delirium) that are independently predictive of survival (4). A disseminated infection can decrease the level of consciousness, activity, and oral intake, or favor the presence of dyspnea and delirium [9], and modify the total score. We assessed whether the survival of patients is dependent on the PPI score calculated at the www.oncotarget.com time of hospital admission, and on the presence or absence of acute concomitant diseases. Modifications to the prognostic ability of the PPI after hospital discharge of patients when symptoms have been controlled and acute concomitant diseases have been resolved were assessed

RESULTS

DISCUSSION

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