Factors associated with mortality in an inpatient acute palliative care unit at a comprehensive cancer center

Abstract

20756 Background: Predicting inpatient mortality has clinical and financial implications and helps improve the care of advanced cancer patients and their families. Models are available for mortality prediction in intensive care units with excellent validity and reliability. The purpose of this study was to determine factors associated with increased likelihood of mortality in an acute palliative care unit (PCU). Methods: We reviewed the medical records of 357 patients admitted to the PCU and collected information regarding demographic factors, tumor type, hospital length of stay, source of admission, and insurance type. Symptom intensity, vital signs, relevant laboratory tests and presence/absence of delirium were obtained from the palliative care consultation preceding PCU admission. Univariate and multivariate analyses were conducted to compare factors in patients who died in the PCU vs. those who were discharged alive. Results: 93 (26%) patients died in the PCU. The results for univariate and multivariate analyses are described in the table. Surprisingly, no statistically significant association was found between inpatient death and delirium or low lymphocyte percentage. Borderline association was found between inpatient death and high bilirubin, high LDH, elevated white blood cell counts and also with hematologic malignancy. Conclusion: We have observed significant association of certain factors with increased likelihood of PCU death in advanced cancer patients. These findings need to be validated in a larger prospective study to develop a model predicting PCU mortality for advanced cancer patients. Factor Univariate Analysis Multivariate Analysis OR p OR p Medicare/Medicaid vs. Private or Self pay 0.59 0.044 Age ≥ 65 vs. < 65 0.49 0.010 0.36 0.001 Consultation team referral vs. Emergency Center 2.54 0.114 1.74 0.380 Consultation team referral vs. outpatient center 4.03 0.005 3.93 0.009 Low platelets (<140.000) 2.15 0.003 Low sodium (<135) 1.81 0.021 2.75 0.001 High sodium (>147) 3.67 0.047 3.05 0.110 Low CO2 (<23) 2.29 0.004 High BUN (>20) 1.93 0.014 High heart rate (≥101) 2.07 0.006 High respiratory rate (≥21) 1.88 0.010 1.80 0.036 Supplemental O2 use 2.80 < 0.001 2.35 0.003 Dyspnea * 1.16 0.002 * Not included in the multivariate model. No significant financial relationships to disclose.