Systematic review of noncancer presentations with a median survival of 6 months or less.
OBJECTIVE
We report on clinical indicators of 6-month mortality in advanced noncancer illnesses and the effect of treatment on survival.


METHODS
The MEDLINE database was searched comprehensively to find studies evaluating survival for common advanced noncancer illnesses. We retrieved and evaluated studies that reported a median survival of ≤1 year and evaluated prognostic factors or effect of treatment on survival. We extracted data on presentations with median survivals of ≤6 months for heart failure, chronic obstructive pulmonary disease, dementia, geriatric failure to thrive, cirrhosis, and end-stage renal failure. Independent risk factors for survival were combined and included if their combination was associated with a 6-month mortality of ≥50%.


RESULTS
The search identified 1000 potentially relevant studies, of which 475 were retrieved and evaluated, and 74 were included. We report the common clinical presentations that are consistently associated with a 6-month median survival. Even though advanced noncancer syndromes differ clinically, a universal set of prognostic factors signals progression to terminal disease, including poor performance status, advanced age, malnutrition, comorbid illness, organ dysfunction, and hospitalization for acute decompensation. Generally, a 6-month median survival is associated with the presence of 2-4 of these factors. With few exceptions, these terminal presentations are quite refractory to treatment.


CONCLUSIONS
This systematic review summarizes prognostic factors common to advanced noncancer illness. There is little evidence at present that treatment prolongs survival at these terminal stages.
Stanford University School of Medicine, CA, USA. salpeter@stanford.edu
Shelley R
SR
Salpeter
Esther J
EJ
Luo
Dawn S
DS
Malter
Brad
B
Stuart
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000401:mortality; D015897:Comorbidity; D006801:Humans; D012307:Risk Factors; D019452:Terminally Ill