Subramaniam Sivakumar, Thorns Andrew, Ridout Martin, Thirukkumaran Thiru, Osborne Thomas Richard
EllenorLions Hospice, Gravesend, UK.
BMJ Support Palliat Care. 2013 Sep;3(3):324-9. doi: 10.1136/bmjspcare-2012-000239. Epub 2013 Apr 19.
The Palliative Prognostic Index (PPI) is a prognostication tool for palliative care patients based on clinical indices developed in Japan and further validated by one study in the UK. The aim of this study was to test its prediction accuracy in a large inpatient hospice sample. The admitting doctor in three inpatient hospices calculated the PPI score on admission. Two hundred and sixty-two patients were included in this study. Based on the PPI score, three subgroups were identified. Group 1 corresponded to patients with PPI ≤4 and the median survival of 53 days (95% CI 40 to 80 days). Group 2 corresponded to those with PPI >4 and ≤6 and the median survival 15 days (95% CI 12 to 26 days) and Group 3 corresponded to patients with PPI >6 and the median survival of 5 days (95% CI 3 to 7 days). In this study, PPI was able to identify patients' likelihood of dying within 3 weeks with a sensitivity of 64% and specificity of 83%. It was able to identify a 6-week survival chance with a sensitivity of 62% and specificity of 86%. A one-unit increase in PPI score was estimated to increase the hazard for death by a factor of 1.33 (95% CI 1.26 to 1.40), based on fitting a stratified Cox proportional hazards model. The authors conclude that PPI can be used to predict prognosis for patients with advanced cancer.
姑息预后指数（PPI）是一种针对姑息治疗患者的预后评估工具，它基于在日本开发的临床指标，并在英国的一项研究中得到进一步验证。本研究的目的是在一个大型住院临终关怀样本中测试其预测准确性。三家住院临终关怀机构的接诊医生在患者入院时计算PPI评分。本研究纳入了262名患者。根据PPI评分，确定了三个亚组。第1组对应PPI≤4的患者，中位生存期为53天（95%CI 40至80天）。第2组对应PPI>4且≤6的患者，中位生存期为15天（95%CI 12至26天），第3组对应PPI>6的患者，中位生存期为5天（95%CI 3至7天）。在本研究中，PPI能够识别患者在3周内死亡的可能性，敏感性为64%，特异性为83%。它能够识别6周生存机会，敏感性为62%，特异性为86%。根据拟合分层Cox比例风险模型，PPI评分每增加一个单位，死亡风险估计增加1.33倍（95%CI 1.26至1.40）。作者得出结论，PPI可用于预测晚期癌症患者的预后。
