对血液系统恶性肿瘤患者临终时预后因素的系统评价。

A systematic review of prognostic factors at the end of life for people with a hematological malignancy.

作者信息

Button Elise, Chan Raymond Javan, Chambers Shirley, Butler Jason, Yates Patsy

机构信息

Royal Brisbane and Women's Hospital, Bowen Bridge Road, Level 5, Block 34, Brisbane, QLD, 4006, Australia.

Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Brisbane, QLD, 4059, Australia.

出版信息

BMC Cancer. 2017 Mar 23;17(1):213. doi: 10.1186/s12885-017-3207-7.

DOI:10.1186/s12885-017-3207-7

PMID:28335744

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5364562/

Abstract

BACKGROUND

Accurate prognosticating is needed when patients are nearing the end of life to ensure appropriate treatment decisions, and facilitate palliative care provision and transitioning to terminal care. People with a hematological malignancy characteristically experience a fluctuating illness trajectory leading to difficulties with prognosticating. The aim of this review was to identify current knowledge regarding 'bedside' prognostic factors in the final 3 months of life for people with a hematological malignancy associated with increased risk of mortality.

METHODS

A systematic review of the literature was performed across: PubMed; CINAHL; PsycINFO; and Cochrane with set inclusion criteria: 1) prognostic cohort studies; 2) published 2004-2014; 3) sample ≥ 18 years; 4) >50% sample had a hematological malignancy; 5) reported 'bedside' prognostic factors; 6) median survival of <3 months; and 7) English language. Quality appraisal was performed using the Quality In Prognostic Studies (QUIPS) tool. Results are reported in line with PRISMA guidelines.

RESULTS

The search returned 4860 studies of which 28 met inclusion criteria. Twenty-four studies were rated moderate quality, three were high quality and one study was deemed to be of low quality. Most studies were set in the ICU (n = 24/28) and were retrospective (n = 25/28). Forty 'bedside' prognostic factors were identified as associated with increased risk of mortality encompassing the following broad categories: 1) demographics; 2) physiological complications or conditions; 3) disease characteristics; 4) laboratory blood values; and 5) interventions.

CONCLUSIONS

The literature on prognosticating in the final months of life was predominantly focused on people who had experienced acute physiological deterioration and were being treated aggressively in the in-patient setting. A significant gap in the literature exists for people who are treated less aggressively or are on a palliative trajectory. Findings did not report on, or confirm the significance of, many of the key prognostic factors associated with increased risk of mortality at the end of life in the solid tumour population, demonstrating key differences in the two populations.

TRIAL REGISTRATION

This systematic review was not registered.

摘要

背景

当患者接近生命末期时，需要进行准确的预后评估，以确保做出适当的治疗决策，并促进姑息治疗的提供以及向终末关怀的过渡。血液系统恶性肿瘤患者的疾病轨迹波动较大，这导致预后评估存在困难。本综述的目的是确定关于血液系统恶性肿瘤患者生命最后3个月中与死亡风险增加相关的“床边”预后因素的现有知识。

方法

对PubMed、CINAHL、PsycINFO和Cochrane进行了系统的文献综述，设定了纳入标准：1）预后队列研究；2）2004年至2014年发表；3）样本年龄≥18岁；4）样本中>50%患有血液系统恶性肿瘤；5）报告了“床边”预后因素；6）中位生存期<3个月；7）英文文献。使用预后研究质量（QUIPS）工具进行质量评估。结果按照PRISMA指南报告。

结果

检索到4860项研究，其中28项符合纳入标准。24项研究质量中等，3项高质量，1项研究质量低。大多数研究在重症监护病房进行（n = 24/28），且为回顾性研究（n = 25/28）。确定了40个与死亡风险增加相关的“床边”预后因素，包括以下广泛类别：1）人口统计学；2）生理并发症或状况；3）疾病特征；4）实验室血液值；5）干预措施。