[Reliability of different criteria in identifying end-of-life trajectory of patients with chronic medical diseases. PALIAR Project].
BACKGROUND
It is a challenge to reliably identify the end-of-life trajectory in patients with advanced-stage chronic medical conditions. This makes advanced supportive care planning and transition from survival to comfort objectives more difficult in these emergent patient populations.


OBJECTIVE
To evaluate the sensitivity (Se), specificity (Sp), positive predictive values (PPV) and negative (NPV), and validity index (IV) of NHO criteria for terminal medical conditions, PPI and ECOG in patients with advanced heart, lung, liver, kidney and/or neurological diseases, and to build and validate an accurate index to determine this border-line.


METHODS
A multicentre prospective cohort study, with inclusion of patients with the predefined advanced medical diseases. Demographic, clinical, care, stratification and staging of disease(s), functional, analytical, NHO criteria, ECOG, PPS and PPI data collection; The end-point (death) will be assessed 180 days after inclusion. Analysis of Se, Sp, PPV, NPV, and IV of the NHO criteria, ECOG scale and PPI at 30, 60, 90, 120, 150 and 180 days. Derivation of PALIAR Index, after multivariate analysis and appropriate weighting of risk factors (beta of risk factor/lowest beta of the model), and validation in the validation cohort, and in the historical PROFUND cohort.


RESULTS
The project is still ongoing, with 50 investigators from 33 hospitals throughout Spain, who have already included 1138 patients (92.5% during hospital admissions, 51.4% of them are male, with a mean age of 78.5 years). Mean inclusion chronic diseases were 1.4 per patient (44.5% of patients suffered chronic neurological diseases, 38.6% with heart failure, 34.2% with lung diseases, 12% with liver diseases, and 6.5% with renal diseases). Around 69% fulfilled the criteria of polypathological patients (mean Charlson index 3.4), and were prescribed around 8 drugs chronically. Mean Barthel index was 40 points, and 77% of them were dependent on a caregiver. Around 46% were ECOG-PS stage III or IV, and mean PPS score was 45 points.


CONCLUSIONS
The availability of an accurate and powerful tool that could enable us to identify the end-of-life trajectory of these patients could allow us to establish specific intervention strategies for these populations. Therefore, and with these preliminary data, we believe that the PALIAR PROJECT will answer with rigour the questions and objectives of the study.
Bernabeu-Wittel
Máximo
M
Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain. maxbw@telefonica.net
Ruiz-Cantero
Alberto
A
Murcia-Zaragoza
José
J
Hernández-Quiles
Carlos
C
Barón-Franco
Bosco
B
Ramos-Cantos
Carmen
C
Nieto-Martín
María Dolores
MD
Fernández-López
Auxiliadora
A
Fernández-Moyano
Antonio
A
Moreno-Gaviño
Lourdes
L
Ollero-Baturone
Manuel
M
D002908:Chronic Disease; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D016730:Program Development; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013727:Terminal Care