Prognostic factors in inpatients with advanced cancer at a palliative care unit

ABSTRACT

Objectives: This study aims to identify prognostic factors and their discriminatory ability in inpatients with advanced cancer at a palliative care unit (PCU).

Material and Methods: Observational, prospective cohort study involving advanced cancer patients (October 2019 to May 2021) of their first admission to a PCU. Sociodemographic, clinical, functional, nutritional, and laboratory variables were evaluated. The outcome was death within 30 days. Kaplan-Meier curves, log-rank test, and Cox proportional hazard model were used to assess prognostic value. The C-statistic was used to test the predictive accuracy of the variables.

Results: Among 136 patients, 77 (56.6%) died within 30 days and the median overall survival was 10 (interquartile range: 6-14) days. The variables of 30-day mortality were tumor in the gastrointestinal tract (GIT) (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.11-2.82), impaired functionality (HR: 1.73, 95%CI: 1.09-3.00), nutritional risk (HR: 4.58, 95%CI: 1.62-12.92), and albumin <3g/dL (HR: 1.88, 95%CI: 1.05-3.34). However, albumin presented acceptable discrimination, with a C-statistic value of 0.75.

Conclusion: Inpatients with advanced cancer in the GIT, impaired functionality, reduced serum albumin, and at nutritional risk have a worse prognosis. Albumin concentration has better discriminatory ability than the other factors identified.

RESUMO

Objetivos: Este estudo tem como objetivo identificar fatores prognósticos e sua capacidade discriminatória em pacientes com câncer avançado internados em uma unidade de cuidados paliativos (UCP).

Material e Métodos: Estudo observacional de coorte prospectivo envolvendo pacientes com câncer avançado (outubro de 2019 a maio de 2021) de sua primeira admissão em uma UCP. Foram avaliadas variáveis sociodemográficas, clínicas, funcionais, nutricionais e laboratoriais. O desfecho foi a morte em 30 dias. Curvas de Kaplan-Meier, teste de logrank e modelo de risco proporcional de Cox foram usados para avaliar o valor prognóstico. A estatística-C foi utilizada para testar a acurácia preditiva das variáveis.

Resultados: Entre 136 pacientes, 77 (56,6%) morreram em 30 dias e a sobrevida global mediana foi de 10 (intervalo interquartil: 6-14) dias. As variáveis de mortalidade em 30 dias foram tumor no trato gastrointestinal (TGI) (taxa de risco [HR]: 1,61, intervalo de confiança de 95% [IC]: 1,11-2,82), funcionalidade prejudicada (HR: 1,73, IC95%: 1,09 -3,00), risco nutricional (HR: 4,58, IC95%: 1,62-12,92) e albumina <3g/dL (HR: 1,88, IC95%: 1,05-3,34). No entanto, a albumina apresentou discriminação aceitável, com valor da estatística-C de 0,75.

Conclusão: Pacientes internados com câncer avançado no TGI, funcionalidade prejudicada, albumina sérica reduzida e em risco nutricional apresentam pior prognóstico. A concentração de albumina tem melhor capacidade discriminatória do que os outros fatores identificados.

Keywords:

Neoplasms - Palliative care - Prognosis - Hospitalization - Mortality

Palavras-chave:

Neoplasias - Cuidado paliativo - Prognóstico - Hospitalização - Mortalidade

Publikationsverlauf

Eingereicht: 10. April 2022

Angenommen: 04. Oktober 2022

Artikel online veröffentlicht:
20. Oktober 2022

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