Predictive Factors for Short-term Mortality in Terminal Cancer Patients Who Visit an Emergency Department

Yang, Seung Hwan; Park, Sung Jun; Lee, Jong Seok; Kwon, Oh Young; Choi, Han Sung; Hong, Hoon Pyo; Ko, Young Gwan

Abstract

PURPOSE: Although some predictive tools are widely used for the prognostic assessment of terminal cancer patients in hospice-palliative care units, it remains unclear which factors predict survival of terminal cancer patients presenting at an emergency department (ED). The aim of this study was to find predictive factors for 1 week and 1 month mortality in ED patients with terminal cancer.
METHODS
We conducted a prospective study on patients with terminal cancer who visited the ED. Patient data included demographics, clinical symptoms and signs, severity scales, and laboratory test results. We estimated differences in survival rate at 1 week and 1 month using Cox-proportional regression analysis. For those variables that were significant, we did multivariate analysis.
RESULTS
One hundred and ten patients were enrolled. The median survival duration was 10 days. Univariate analysis showed that tachypnea, tachycardia, hypotension, cognitive dysfunction and acute renal dysfunction were statistically significant predictors of mortality. The Eastern Cooperative Oncology Group score, the Sequential Organ Failure Assessment score, leukocyte and neutrophil counts, serum levels of C-reactive protein (CRP), blood urea nitrogen (BUN), creatinine and sodium were also predictors of mortality. Multivariate analysis showed that hypotension and serum levels of CRP, BUN and sodium were independent predictors.
CONCLUSION
In ED patients with terminal cancer, hypotension and serum levels of CRP, BUN and sodium may be useful for predicting 1 week and 1 month mortality.