Hosoi Takahiro, Ozone Sachiko, Hamano Jun, Maruo Kazushi, Maeno Tetsuhiro
Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Japan.
Kamisu Clinical Education and Training Center, Faculty of Medicine, University of Tsukuba, Kamisu, Japan.
Palliat Med Rep. 2021 Oct 21;2(1):287-295. doi: 10.1089/pmr.2021.0029. eCollection 2021.
Accurate information on the prognosis in the last days of life is essential for providing better end-of-life care; however, few studies have examined the signs of impending death (SID) or developed short-term prediction models in noncancer patients. To investigate the prevalence and onset of SID and to develop models that predict death within 7 days, 72 hours, and 24 hours in noncancer patients. This is a prospective longitudinal observational study. Subjects were noncancer patients admitted to a hospital in Japan between 2019 and 2020. We investigated 11 physical signs and vital signs every 12 hours until death after confirming a reduced daily oral intake to less than a few mouthfuls. We analyzed data from 50 noncancer patients. The prediction model "pulselessness of the radial artery OR respiration of mandibular movement OR the shock Index (SI) >1.0" predicted death within 7 days with an accuracy of 83.9%, whereas the models developed to predict death within 72 and 24 hours had an accuracy of 65.0% or less. The median onset of all signs was within 3 days of death. The frequencies of decreased response to verbal stimuli and decreased response to visual stimuli were 76.0% and 74.0%, respectively. The prediction model using physical signs and SI predicted death within 7 days in noncancer patients with high accuracy. The prediction of death within 72 and 24 hours in noncancer patients requires investigation of physical signs not examined in this study.
准确的临终预后信息对于提供更好的临终关怀至关重要；然而，很少有研究在非癌症患者中检查濒死迹象（SID）或开发短期预测模型。为了调查SID的患病率和发作情况，并开发能够预测非癌症患者在7天、72小时和24小时内死亡的模型。这是一项前瞻性纵向观察研究。研究对象为2019年至2020年期间入住日本一家医院的非癌症患者。在确认每日口服摄入量减少至几口以下后，每12小时对11项身体体征和生命体征进行一次调查，直至患者死亡。我们分析了50名非癌症患者的数据。预测模型“桡动脉无脉搏或下颌运动呼吸或休克指数（SI）>1.0”预测7天内死亡的准确率为83.9%，而用于预测72小时和24小时内死亡的模型准确率在65.0%或更低。所有体征出现的中位时间在死亡前3天内。对言语刺激反应降低和对视觉刺激反应降低的频率分别为76.0%和74.0%。使用身体体征和SI的预测模型能高精度地预测非癌症患者7天内的死亡情况。非癌症患者72小时和24小时内死亡的预测需要对本研究未检查的身体体征进行调查。
