Stanford University School of Medicine, CA, USA.
Am J Med. 2012 May;125(5):512.e1-6. doi: 10.1016/j.amjmed.2011.07.028. Epub 2011 Oct 24.
We report on clinical indicators of 6-month mortality in advanced noncancer illnesses and the effect of treatment on survival.
The MEDLINE database was searched comprehensively to find studies evaluating survival for common advanced noncancer illnesses. We retrieved and evaluated studies that reported a median survival of ≤1 year and evaluated prognostic factors or effect of treatment on survival. We extracted data on presentations with median survivals of ≤6 months for heart failure, chronic obstructive pulmonary disease, dementia, geriatric failure to thrive, cirrhosis, and end-stage renal failure. Independent risk factors for survival were combined and included if their combination was associated with a 6-month mortality of ≥50%.
The search identified 1000 potentially relevant studies, of which 475 were retrieved and evaluated, and 74 were included. We report the common clinical presentations that are consistently associated with a 6-month median survival. Even though advanced noncancer syndromes differ clinically, a universal set of prognostic factors signals progression to terminal disease, including poor performance status, advanced age, malnutrition, comorbid illness, organ dysfunction, and hospitalization for acute decompensation. Generally, a 6-month median survival is associated with the presence of 2-4 of these factors. With few exceptions, these terminal presentations are quite refractory to treatment.
This systematic review summarizes prognostic factors common to advanced noncancer illness. There is little evidence at present that treatment prolongs survival at these terminal stages.
本研究报告了晚期非癌症疾病 6 个月死亡率的临床指标，以及治疗对生存率的影响。
全面检索 MEDLINE 数据库，以寻找评估常见晚期非癌症疾病生存率的研究。我们检索并评估了报告中位生存时间≤1 年且评估预后因素或治疗对生存率影响的研究。我们提取了心力衰竭、慢性阻塞性肺疾病、痴呆、老年衰竭、肝硬化和终末期肾病等中位生存时间≤6 个月的表现的数据。将独立的生存风险因素进行合并，如果它们的组合与 6 个月死亡率≥50%相关，则将其包括在内。
搜索确定了 1000 篇潜在相关的研究，其中 475 篇被检索和评估，74 篇被纳入。我们报告了与 6 个月中位生存时间相关的常见临床表现。尽管晚期非癌症综合征在临床上存在差异，但一组普遍的预后因素表明疾病进展到终末期，包括身体状况不佳、年龄较大、营养不良、合并疾病、器官功能障碍和急性失代偿住院治疗。通常，这些因素中有 2-4 个存在与 6 个月中位生存时间相关。除了少数例外，这些终末期表现对治疗的反应相当差。
本系统综述总结了晚期非癌症疾病的常见预后因素。目前几乎没有证据表明治疗能在这些终末期延长生存时间。
