title: Prognostication based on the change in the palliative prognostic index for patients with terminal cancer.
abstract: BACKGROUND
  The use of the Palliative Prognostic Index (PPI) in relation to the clinical time course has not yet been established.
  
  
  OBJECTIVE
  To investigate the association between the changes in the PPI over time and the survival of terminal cancer patients in a palliative care unit (PCU).
  
  
  METHODS
  This retrospective cohort study analyzed data from 374 terminal cancer patients who were admitted to the PCU of a university hospital in Japan. Clinical data, such as age, gender, body mass index, vital signs, initial PPI, and subsequent PPI, were collected from the medical records. The PPI change per day (ΔPPI) was calculated using the initial PPI at admission and the one after five to seven days. The factors associated with death within three weeks were identified using Cox proportional hazards model analysis.
  
  
  RESULTS
  After their admission to the PCU, 147 (39.3%) patients were deceased within three weeks. The multivariate-adjusted analysis showed that body temperature (hazard ratio [HR] 0.7; 95% CI 0.5, 1.0), initial PPI (HR 1.3; 95% CI 1.2, 1.4), and ΔPPI (HR 6.6; 95% CI 4.9, 9.0) were significantly and independently associated with death within three weeks. In the subanalysis, the ΔPPI was significantly associated with death within three weeks in the group with initial PPI ≤ 4 (HR 9.3; 95% CI 5.8, 15.0), 4 < initial PPI ≤ 6 (HR 14.4; 95% CI 5.7, 36.2), and initial PPI > 6 (HR 9.0; 95% CI 4.1, 20.0).
  
  
  CONCLUSIONS
  Our data suggest that the ΔPPI may be useful for predicting the survival of terminally ill cancer patients.
authors.affiliation: Division of Palliative Care Medicine, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan. Electronic address: 96079ym@jichi.ac.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Arai
authors.affiliation: Division of Palliative Care Medicine, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Okajima
authors.affiliation: Department of Clinical Laboratory Medicine and Public Health, Jichi Medical University, School of Medicine, Shimotsuke, Tochigi, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kotani
authors.affiliation: Division of Palliative Care Medicine, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan.
authors.forename: Kaichiro
authors.initials: K
authors.lastname: Tamba
mesh_terms: D000368:Aged; D001831:Body Temperature; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D010166:Palliative Care; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors
keywords: PPI; Palliative Prognostic Index; illness trajectory; palliative care; prognostication