title: Individual prognostic assessment in the intensive care unit: can therapeutic persistence be distinguished from therapeutic obstinacy?
abstract: OBJECTIVE
  Availability of state-of-the-art technology at intensive care units has often turned into a tool aggravating suffering by prolonging the end-of-life process. Distinguishing therapeutic persistence from therapeutic obstinacy has become a great challenge for present-day medicine. The aim of this study was to assess the benefit-harm relation in the use of life-sustaining therapies by means of an evolutionary system of individual prognostic assessment.
  
  
  METHODS
  A cohort, prospective, observational study at the intensive care unit of the São Francisco De Paula University Hospital of UCPel, Pelotas RS from March 2006 to August 31, 2007. Individual prognostic assessments were recorded by using an evolutionary system, the UNICAMP II index, associated with albumin transferrin and lymphocytes serum levels, life- sustaining therapies and the outcome. Statistical analysis was carried out by the Student's t-test, ANOVA test, Chi-square test, Fisher's exact test, Spearman's correlation test and area under the receiver-operating characteristic curve. A p value < 0.05 was considered statistically significant.
  
  
  RESULTS
  Four hundred forty seven patients were assessed during the study. Prevalence of death was significantly higher among those who received life-sustaining therapies at a later stage of the intervention, and those whose prognostic index and nutritional status worsened at an early stage of intervention.
  
  
  CONCLUSIONS
  Assessment of individual evolutionary prognostic proved to be a useful method to objectively subsidize ethical decisions related to therapeutic persistence and therapeutic obstinacy.
authors.affiliation: Universidade Católica de Pelotas, Pelotas, RS, Brasil.
authors.forename: Cristiano Corrêa
authors.initials: CC
authors.lastname: Batista
authors.affiliation: Universidade Católica de Pelotas, Pelotas, RS, Brasil.
authors.forename: Caroline de Arriada
authors.initials: Cde A
authors.lastname: Gattass
authors.affiliation: Universidade Católica de Pelotas, Pelotas, RS, Brasil.
authors.forename: Talita Pereira
authors.initials: TP
authors.lastname: Calheiros
authors.affiliation: Universidade Católica de Pelotas, Pelotas, RS, Brasil.
authors.forename: Raquel Balhinhas de
authors.initials: RB
authors.lastname: Moura