title: Changes in symptoms and inpatient mortality: a study in advanced cancer patients admitted to an acute palliative care unit in a comprehensive cancer center.
abstract: BACKGROUND
  Although several symptoms have been shown to predict survival, little is known of the roles of symptom changes in predicting inpatient death.
  
  
  OBJECTIVE
  To determine the association between changes in symptoms and inpatient mortality among advanced cancer patients in an acute palliative care unit (APCU).
  
  
  METHODS
  We retrospectively reviewed the medical records of 166 consecutive cancer patients admitted to our APCU from the emergency center (EC) or clinic from June 2006 to December 2007. We recorded symptom severity and presence of delirium on admission (baseline) and on the third, fourth, or fifthth day, whichever appeared first (follow-up). The primary endpoint was the vital status at discharge. Univariate (UVA) and multivariate analyses (MVA) were used to estimate the odds of inpatient death.
  
  
  RESULTS
  One hundred and thirty-four patients (80.7%) were discharged alive and 32 (19.3%) died in the APCU. All symptoms significantly improved at follow-up. In UVA, persistent delirium was significantly associated with inpatient mortality (odds ratio [OR] 2.59, 95% confidence interval [CI 1] 0.09-6.17, p = 0.031), although presence of baseline delirium was not. MVA revealed that greater risk of dying was jointly correlated with a high level of baseline dyspnea (OR 1.35, 95% CI 1.13-1.61, p = 0.001) and drowsiness (OR 1.25, 95% CI 1.04-1.50, p = 0.02), low level of baseline anxiety (OR 0.83, 95% CI 0.70-0.99, p = 0.038), and transfer from EC (OR 6.78, 95% CI 1.99-23.14, p = 0.002). Worsened depression was significantly related with death in UVA (OR 1.30, 95% CI 1.08-1.56, p < 0.001), but not in MVA.
  
  
  CONCLUSIONS
  Changes in certain symptoms, such as worsened depression and persistent delirium, might be important predictors of inpatient death.
authors.affiliation: Division of Hematology and Oncology, Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, Vermont, USA.
authors.forename: Masanori
authors.initials: M
authors.lastname: Mori
authors.forename: Henrique A
authors.initials: HA
authors.lastname: Parsons
authors.forename: Maxine
authors.initials: M
authors.lastname: De la Cruz
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elsayem
authors.forename: Shana L
authors.initials: SL
authors.lastname: Palla
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Li
authors.forename: Lynn
authors.initials: L
authors.lastname: Palmer
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.forename: Nada A
authors.initials: NA
authors.lastname: Fadul
mesh_terms: D000368:Aged; D002173:Cancer Care Facilities; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care; D010166:Palliative Care; D012189:Retrospective Studies