The application of the Palliative Prognostic Index, charlson comorbidity index, and Glasgow Prognostic Score in predicting the life expectancy of patients with hematologic malignancies under palliative care.
BACKGROUND
The clinical course for hematologic malignancy varies widely and no prognostic tool is available for patients with a hematologic malignancy under palliative care. To assess the application of the Palliative Prognostic Index (PPI), Charlson Comorbidity Index (CCI), and Glasgow Prognostic Score (GPS) as prognostic tools in patients with hematologic malignancies under palliative care.


METHODS
We included 217 patients with pathologically proven hematologic malignancies under palliative care consultation service (PCCS) between January 2006 and December 2012 at a single medical center in Taiwan. Patients were categorized into subgroups by PPI, CCI, and GPS for survival analysis.


RESULTS
The median survival was 16 days (interquartile range, 4-47.5 days) for all patients and 204 patients (94%) died within 180 days after PCCS. There was a significant difference in survival among patients categorized using the PPI (median survival 49, 15, and 7 days in patients categorized into a good, intermittent, and poor prognostic group, respectively) and the GPS (median survival 66 and 13 days for GPS 0 and 1, respectively). There was no difference in survival between patients with a GPS score of 0 versus 2, or a CCI score of 0 versus ≥1. The survival time was significantly discriminated after stratifying patients with a good PPI score based on the CCI (median survival 102 and 41 days in patients with a CCI score of 0 and ≥1, respectively) from those with a poor PPI score by using the GPS (median survival 47 and 7 days in patients with GPS scores of 0 and 1-2, respectively).


CONCLUSIONS
PPI is a useful prognosticator of life expectancy in terminally ill patients under palliative care for a hematologic malignancy. Concurrent use of the GPS and CCI improved the accuracy of prognostication using the PPI.
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou branch, and School of Medicine, Chang Gung University, No. 5 Fuxing Street, Guishan Township, Taoyuan, Taiwan. wenchi3992@yahoo.com.tw.
Wen-Chi
WC
Chou
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou branch, and School of Medicine, Chang Gung University, No. 5 Fuxing Street, Guishan Township, Taoyuan, Taiwan. kao2880@cgmh.org.tw.
Chen-Yi
CY
Kao
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou branch, and School of Medicine, Chang Gung University, No. 5 Fuxing Street, Guishan Township, Taoyuan, Taiwan. pnwang@cgmh.org.tw.
Po-Nan
PN
Wang
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou branch, and School of Medicine, Chang Gung University, No. 5 Fuxing Street, Guishan Township, Taoyuan, Taiwan. horng@cgmh.org.tw.
Hung
H
Chang
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou branch, and School of Medicine, Chang Gung University, No. 5 Fuxing Street, Guishan Township, Taoyuan, Taiwan. whm526@cgmh.org.tw.
Hung-Ming
HM
Wang
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital Keelung branch, Keelung, Taiwan. ph555chang@cgmh.org.tw.
Pei-Hung
PH
Chang
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital Keelung branch, Keelung, Taiwan. yeh0304@cgmh.org.tw.
Kun-Yun
KY
Yeh
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou branch, and School of Medicine, Chang Gung University, No. 5 Fuxing Street, Guishan Township, Taoyuan, Taiwan. f22338@cgmh.org.tw.
Yu-Shin
YS
Hung
D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D005260:Female; D006305:Health Status Indicators; D019337:Hematologic Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology; D019452:Terminally Ill; D013997:Time Factors