Korean J Med.  2011 Sep;81(3):359-365.

Survival Prediction in Terminally Ill Cancer Patients: Laboratory Variables and Prospective Validation of The Palliative Prognostic Index

• Son HR
• Kim DE
• Kang HW
• Kim HN
• Seo IK
• Yoon JY
• Hwang JE
• Shim HJ
• Cho SH
• Chung IJ
• Bae WK

Abstract

BACKGROUND/AIMS
The palliative prognostic index (PPI) was designed to predict life expectancy based on clinical symptoms. In this study, a PPI was constructed and used with other biological parameters to predict 3-week survival in patients with advanced cancer.
METHODS
The study included 222 patients. The PPI was constructed with five variables (performance status, oral intake, edema, dyspnea at rest, and delirium). PPI scores were grouped as follows: 4 (group 1); > 4 and < or = 6 (group 2); and > 6 (group 3). At admission, seven biological variables (white blood cell count, lymphocyte, C-reactive protein [CRP], bilirubin, albumin, creatinine, and lactate dehydrogenase) were measured.
RESULTS
The overall survival duration was 50 days in group 1, 22 days in group 2, and 14 days in groups 3. Using the PPI, a survival of < 3 weeks in group 3 was predicted with a sensitivity of 76.5% and a specificity of 65.4%. The important factors significantly affecting the 3-week survival rate were a PPI score > 6 and increases in serum bilirubin and CRP levels. Furthermore, the 3-week survival rate in patients with hepatopancreatobiliary cancer was more accurately predicted using a combination of the PPI, CRP, and serum bilirubin levels.
CONCLUSIONS
Although a PPI has limitations, it can be quickly applied to determine survival duration in patients admitted to hospice and accurately predicts 3-week survival. Furthermore, bilirubin and CRP are useful factors for predicting 3-week survival in patients with gastrointestinal cancer, including hepatopancreatobiliary cancer.

Keyword

Hospice Care; Survival Analysis; Bilirubin

MeSH Terms

Bilirubin
Blood Cell Count
C-Reactive Protein
Creatinine
Dyspnea
Edema
Gastrointestinal Neoplasms
Hospice Care
Hospices
Humans
Lactic Acid
Life Expectancy
Lymphocytes
Prospective Studies
Sensitivity and Specificity
Survival Analysis
Survival Rate
Terminally Ill
Bilirubin
C-Reactive Protein
Creatinine
Lactic Acid