title: Variations in vital signs in the last days of life in patients with advanced cancer.
abstract: BACKGROUND
  Few studies have examined variation in vital signs in the last days of life.
  
  
  OBJECTIVE
  We determined the variation of vital signs in the final two weeks of life in patients with advanced cancer and examined their association with impending death in three days.
  
  
  METHODS
  In this prospective, longitudinal, observational study, we enrolled consecutive patients admitted to two acute palliative care units and documented their vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation, and temperature) twice a day serially from admission to death or discharge.
  
  
  RESULTS
  Of 357 patients, 203 (57%) died in hospital. Systolic blood pressure (P < 0.001), diastolic blood pressure (P < 0.001), and oxygen saturation (P < 0.001) decreased significantly in the final three days of life, and temperature increased slightly (P < 0.04). Heart rate (P = 0.22) and respiratory rate (P = 0.24) remained similar in the last three days. Impending death in three days was significantly associated with increased heart rate (odds ratio [OR] = 2; P = 0.01), decreased systolic blood pressure (OR = 2.5; P = 0.004), decreased diastolic blood pressure (OR = 2.3; P = 0.002), and decreased oxygen saturation (OR = 3.7; P = 0.003) from baseline readings on admission. These changes had high specificity (≥ 80%), low sensitivity (≤ 35%), and modest positive likelihood ratios (≤ 5) for impending death within three days. A large proportion of patients had normal vital signs in the last days of life.
  
  
  CONCLUSIONS
  Blood pressure and oxygen saturation decreased in the last days of life. Clinicians and families cannot rely on vital sign changes alone to rule in or rule out impending death. Our findings do not support routine vital signs monitoring of patients who are imminently dying.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bruera
authors.affiliation: Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Chisholm
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: Dos Santos
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Camila
authors.initials: C
authors.lastname: Crovador
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. Electronic address: dhui@mdanderson.org.
authors.forename: David
authors.initials: D
authors.lastname: Hui
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D010808:Physical Examination / Q000706:statistics & numerical data*; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D013534:Survival; D013727:Terminal Care / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000706:statistics & numerical data*; D055986:Vital Signs; D055815:Young Adult
keywords: Blood pressure; death; diagnosis; heart rate; impending death; neoplasms; oxygen; physiologic phenomena; respiratory rate; temperature
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