Taylor Paul, Crouch Simon, Howell Debra A, Dowding Dawn W, Johnson Miriam J
St Benedict's Hospice, Sunderland, UK
University of York, York, UK.
Palliat Med. 2015 Feb;29(2):120-7. doi: 10.1177/0269216314554967. Epub 2014 Dec 18.
Recognising dying remains a difficult clinical skill which has gained increasing importance in the United Kingdom since the Neuberger review. Clinical and research methods exist to aid recognition of dying but do not exhibit the level of accuracy required for such an important decision.
To explore change in key clinical parameters as cancer patients near the end of life.
This is a retrospective cohort study of terminally ill patients. Data were collected from hospital case-notes. Case-note data were analysed using multilevel modelling to explore absolute values and rates of change of given variables.
SETTING/PARTICIPANTS: Hospital in-patients who died from solid-tumour malignancies within a 3-month period in 2009 formed the cohort. The setting was an acute hospital trust in the North of England.
A total of 15,337 data points from the case-notes of 102 patients were analysed. There was a clinically and statistically significant deterioration in respiratory function and renal function over the last 2 weeks of life. Heart rate and serum sodium also changed but did not vary greatly from normal limits. White cell parameters, haemoglobin and albumin showed evidence for change over longer periods.
Results demonstrate statistically and clinically significant change in routinely measured respiratory and renal function variables during the final 2 weeks of life in people dying with cancer. Although useful in acute early warning scores, in a terminally ill patient, relative haemodynamic stability should not be interpreted as reassuring. Further work is needed to understand how these findings apply to the individual or inform other prognostic work.
自纽伯格审查以来，在英国，识别临终状态仍然是一项困难的临床技能，但其重要性日益增加。现有的临床和研究方法有助于识别临终状态，但对于如此重要的决策而言，其准确性水平仍未达标。
探讨癌症患者临终前关键临床参数的变化。
这是一项对绝症患者的回顾性队列研究。数据收集自医院病历。使用多水平模型分析病历数据，以探究给定变量的绝对值和变化率。
设置/参与者：2009年3个月内死于实体瘤恶性肿瘤的医院住院患者组成了该队列。研究地点是英格兰北部的一家急性医院信托机构。
共分析了102名患者病历中的15337个数据点。在生命的最后2周，呼吸功能和肾功能出现了具有临床意义和统计学意义的恶化。心率和血清钠也发生了变化，但与正常范围相比变化不大。白细胞参数、血红蛋白和白蛋白在较长时间内显示出变化迹象。
结果表明，在癌症临终患者生命的最后2周，常规测量的呼吸和肾功能变量出现了具有统计学意义和临床意义的变化。尽管相对血流动力学稳定性在急性早期预警评分中有用，但在绝症患者中，不应将其视为令人安心的指标。需要进一步开展工作，以了解这些发现如何应用于个体或为其他预后工作提供信息。
