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晚期癌症患者在姑息治疗中住院死亡的预测因素。

Predictive Factors of Death on Hospitalization in Patients With Advanced Cancer in Palliative Care.

机构信息

37908National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil.

出版信息

Am J Hosp Palliat Care. 2021 Oct;38(10):1189-1194. doi: 10.1177/1049909120976398. Epub 2020 Dec 3.

Abstract

BACKGROUND

Prognostic assessment is essential to plan the care of patients with advanced cancer in palliative care.

OBJECTIVE

Thus, this study aims to assess the predictors of death in inpatients with advanced cancer in palliative care.

METHODS

This is a clinical, observational cohort study with patients aged >20 years, of both genders, evaluated within 48 hours of the first hospitalization. The independent variables were tumor location, nutritional risk [through the Patient-Generated Subjective Global Assessment (PG-SGA) short form], laboratory tests [C-reactive protein and albumin] and Karnofsky Performance Status (KPS). Logistic regression analyses were performed.

RESULTS

Eighty-two patients were evaluated, whose mean age was 61.8 (± 13.2) years. Forty-nine (59.8%) patients died during hospitalization, among which the majority had KPS of 30-40% (p-value = 0.043), higher means of the total score of the PG-SGA (p-value = 0.050) and lower serum albumin concentrations (p-value = 0.011). According to the multivariate model, tumor location in the gastrointestinal (GI) tract (OR: 1.73; 95% CI: 1.57-1.94), 30-40% KPS (OR: 1.29; 95% CI: 1.07-1.63) and albumin concentrations <3.5 g/dL (OR: 4.65; 95% CI: 1.22-17.7) were independent factors associated with an increased chance of death from hospitalization.

CONCLUSION

Presenting an advanced tumor with localization in the GI tract, KPS ≤40% and serum albumin concentration <3.5 g/dL at admission were predictors of death in inpatients under palliative care.

摘要

背景

在姑息治疗中,对晚期癌症患者进行预后评估对于规划患者的护理至关重要。

目的

因此,本研究旨在评估姑息治疗中晚期癌症住院患者的死亡预测因素。

方法

这是一项临床观察性队列研究,纳入年龄>20 岁的男女患者,在首次住院后 48 小时内进行评估。自变量包括肿瘤位置、营养风险(通过患者生成的主观整体评估量表(PG-SGA)短表)、实验室检查[C 反应蛋白和白蛋白]和卡诺夫斯基表现状态(KPS)。进行了逻辑回归分析。

结果

共评估了 82 名患者,其平均年龄为 61.8(±13.2)岁。49 名(59.8%)患者在住院期间死亡,其中大多数患者的 KPS 为 30-40%(p 值=0.043),PG-SGA 总评分较高(p 值=0.050),血清白蛋白浓度较低(p 值=0.011)。根据多变量模型,胃肠道(GI)部位的肿瘤位置(OR:1.73;95%CI:1.57-1.94)、30-40%的 KPS(OR:1.29;95%CI:1.07-1.63)和白蛋白浓度<3.5g/dL(OR:4.65;95%CI:1.22-17.7)是与住院期间死亡风险增加相关的独立因素。

结论

入院时存在进展期肿瘤,肿瘤位于 GI 部位,KPS≤40%,血清白蛋白浓度<3.5g/dL,是姑息治疗住院患者死亡的预测因素。

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