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The (un)availability of prognostic information in the last days of life: a prospective observational study.

ABSTRACT: OBJECTIVES:The aims of this study were (1) to document the clinical condition of patients considered to be in the last 2?weeks of life and (2) to compare patients who did or did not survive for 72?hours. DESIGN:A prospective observational study. SETTING:Two sites in London, UK (a hospice and a hospital palliative care team). PARTICIPANTS:Any inpatient, over 18 years old, English speaking, who was identified by the palliative care team as at risk of dying within the next 2?weeks was eligible. OUTCOME MEASURES:Prognostic signs and symptoms were documented at a one off assessment and patients were followed up 7 days later to determine whether or not they had died. RESULTS:Fifty participants were recruited and 24/50 (48%) died within 72?hours of assessment. The most prevalent prognostic features observed were a decrease in oral food intake (60%) and a rapid decline of the participant's global health status (56%). Participants who died within 72?hours had a lower level of consciousness and had more care needs than those who lived longer. A large portion of data was unavailable, particularly that relating to the psychological and spiritual well-being of the patient, due to the decreased consciousness of the patient. CONCLUSIONS:The prevalence of prognostic signs and symptoms in the final days of life has been documented between those predicted to die and those who did not. How doctors make decisions with missing information is an area for future research, in addition to understanding the best way to use the available information to make more accurate predictions.

SUBMITTER: White N

PROVIDER: S-EPMC6624101 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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The (un)availability of prognostic information in the last days of life: a prospective observational study.

White Nicola N Reid Fiona F Harries Priscilla P Harris Adam J L AJL Minton Ollie O McGowan Catherine C Lodge Philip P Tookman Adrian A Stone Patrick P

BMJ open 20190709 7

<h4>Objectives</h4>The aims of this study were (1) to document the clinical condition of patients considered to be in the last 2 weeks of life and (2) to compare patients who did or did not survive for 72 hours.<h4>Design</h4>A prospective observational study.<h4>Setting</h4>Two sites in London, UK (a hospice and a hospital palliative care team).<h4>Participants</h4>Any inpatient, over 18 years old, English speaking, who was identified by the palliative care team as at risk of dying within the n ...[more]

PMID: 31292186

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Project description:BackgroundMetastatic breast cancer (MBC) is a challenging disease, and despite new therapies, prognosis is still poor for a majority of patients. There is a clinical need for improved prognostication where immuno-oncology markers can provide important information. The aim of this study was to evaluate serum immuno-oncology markers in MBC patients and their respective relevance for prediction of survival.Patients and methodsWe investigated a broad panel of 92 immuno-oncology proteins in serum from 136 MBC patients included in a prospective observational study (NCT01322893) with long-term follow-up. Serum samples were collected before start of systemic therapy and analyzed using multiplex proximity extension assay (Olink Target 96 Immuno-Oncology panel). Multiple machine learning techniques were used to identify serum markers with highest importance for prediction of overall and progression-free survival (OS and PFS), and associations to survival were further evaluated using Cox regression analyses. False discovery rate was then used to adjust for multiple comparisons.ResultsUsing random forest and random survival forest analyses, we identified the top nine and ten variables of highest predictive importance for OS and PFS, respectively. Cox regression analyses revealed significant associations (P < 0.005) of higher serum levels of IL-8, IL-10 and CAIX with worse OS in multivariable analyses, adjusted for established clinical prognostic factors including circulating tumor cells (CTCs). Similarly, high serum levels of IL-8, IL-10, ADA and CASP8 significantly associated with worse PFS. Interestingly, high serum levels of FasL significantly associated with improved OS and PFS. In addition, CSF-1, IL-6, MUC16, TFNSFR4 and CD244 showed suggestive evidence (P < 0.05) for an association to survival in multivariable analyses. After correction for multiple comparisons, IL-8 still showed strong evidence for correlation to survival.ConclusionTo conclude, we found six serum immuno-oncology markers that were significantly associated with OS and/or PFS in MBC patients, independently of other established prognostic factors including CTCs. Furthermore, an additional five serum immuno-oncology markers provided suggestive evidence for an independent association to survival. These findings highlight the relevance of immuno-oncology serum markers in MBC patients and support their usefulness for improved prognostication. Trial registration Clinical Trials (NCT01322893), registered March 25, 2011.

Project description:OBJECTIVE:The relationship between admission nutritional status and clinical outcomes following hospital discharge is not well established. This study investigated whether older patients' nutritional status at admission predicts unplanned readmission or death in the very early or late periods following hospital discharge. DESIGN, SETTING AND PARTICIPANTS:The study prospectively recruited 297 patients ?60 years old who were presenting to the General Medicine Department of a tertiary care hospital in Australia. Nutritional status was assessed at admission by using the Patient-Generated Subjective Global Assessment (PG-SGA) tool, and patients were classified as either nourished (PG-SGA class A) or malnourished (PG-SGA classes B and C). A multivariate logistic regression model was used to adjust for other covariates known to influence clinical outcomes and to determine whether malnutrition is a predictor for early (0-7 days) or late (8-180 days) readmission or death following discharge. OUTCOME MEASURES:The impact of nutritional status was measured on a combined endpoint of any readmission or death within 0-7 days and between 8 and 180 days following hospital discharge. RESULTS:Within 7?days following discharge, 29 (10.5%) patients had an unplanned readmission or death whereas an additional 124 (50.0%) patients reached this combined endpoint within 8-180 days postdischarge. Malnutrition was associated with a significantly higher risk of combined endpoint of readmissions or death both within 7?days (OR 4.57, 95%?CI 1.69 to 12.37, P<0.001) and within 8-180 days (OR 1.98, 95%?CI 1.19 to 3.28, P=0.007) following discharge and this risk remained significant even after adjustment for other covariates. CONCLUSIONS:Malnutrition in older patients at the time of hospital admission is a significant predictor of readmission or death both in the very early and in the late periods following hospital discharge. Nutritional state should be included in future risk prediction models. TRIAL REGISTRATION NUMBER:ACTRN No. 12614000833662; Post-results.

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The (un)availability of prognostic information in the last days of life: a prospective observational study.

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The (un)availability of prognostic information in the last days of life: a prospective observational study.

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