Cheng Wei-Hong, Kao Chen-Yi, Hung Yu-Shin, Su Po-Jung, Hsieh Chia-Hsun, Chen Jen-Shi, Wang Hung-Ming, Chou Wen-Chi
Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Asian Pac J Cancer Prev. 2012;13(6):2861-6. doi: 10.7314/apjcp.2012.13.6.2861.
The aim of our study was to assess the practical utility of the palliative prognostic index (PPI) as a prognostic tool used by nurse specialists in a hospice consultation setting in Taiwan.
In total, 623 terminal cancer patients under hospice consultation care from one medical center in northern Taiwan were enrolled between January 1 and June 30, 2011. PPI was assessed by a nurse specialist at first hospice consultation and patients categorized into groups by prognosis (good, intermediate, poor). Patient survival was analyzed retrospectively to determine significance of between-group differences.
By PPI sum score, 37.2% of patients were in the good prognosis group, 18% in the intermediate prognosis group and 44.8% in the poor prognosis group. The death rates were 56%, 81.2% and 89.6% and median survivals were 76, 18 and 7 days, respectively. The hazard ratio was 0.19 (95% confidence interval [CI] 0.10-0.24, p<0.001) for the poor versus good prognosis group and 0.54 (95% CI 0.43-0.69, p<0.001) for the poor versus intermediate prognosis group. The sensitivity and specificity for the poor prognosis group was 66% and 71%; the positive predictive value and negative predictive value were 81% and 52%, respectively, to predict patient death within 21 days (area under the curve of the receiver operating characteristic was 0.68).
Assessment by PPI can accurately predict survival of terminal cancer patients receiving hospice consultation care. PPI is a simple tool and can be administered by nurse members of hospice consultation teams.
我们研究的目的是评估姑息预后指数（PPI）作为台湾临终关怀咨询环境中护士专家使用的预后工具的实际效用。
2011年1月1日至6月30日期间，总共纳入了台湾北部一家医疗中心接受临终关怀咨询护理的623例晚期癌症患者。在首次临终关怀咨询时由护士专家评估PPI，并根据预后（良好、中等、差）将患者分组。对患者生存情况进行回顾性分析，以确定组间差异的显著性。
根据PPI总分，37.2%的患者处于预后良好组，18%处于预后中等组，44.8%处于预后差组。死亡率分别为56%、81.2%和89.6%，中位生存期分别为76天、18天和7天。预后差组与预后良好组的风险比为0.19（95%置信区间[CI]0.10 - 0.24，p<0.001），预后差组与预后中等组的风险比为0.54（95%CI 0.43 - 0.69，p<0.001）。预后差组预测患者在21天内死亡的敏感性和特异性分别为66%和71%；阳性预测值和阴性预测值分别为81%和52%（受试者操作特征曲线下面积为0.68）。
通过PPI评估可以准确预测接受临终关怀咨询护理的晚期癌症患者的生存情况。PPI是一个简单的工具，可由临终关怀咨询团队的护士成员进行评估。
