Goh Zhong Ning Leonard, Chen Mu-Wei, Cheng Hao-Tsai, Hsu Kuang-Hung, Seak Chen-Ken, Seak Joanna Chen-Yeen, Ling Seng Kit, Liao Shao-Feng, Cheng Tzu-Heng, Sie Yi-Da, Li Chih-Huang, Chen Hsien-Yi, Chien Cheng-Yu, Seak Chen-June
Sarawak General Hospital, Kuching 93586, Sarawak, Malaysia.
Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan.
J Pers Med. 2022 Jun 10;12(6):954. doi: 10.3390/jpm12060954.
Advanced cancer patients who are not expected to survive past the short term can benefit from early initiation of palliative care in the emergency department (ED). This discussion, however, requires accurate prognostication of their short-term survival. We previously found in our retrospective study that shock index (SI) is an ideal risk stratification tool in predicting the 60-day mortality risk of advanced cancer patients presenting to the ED. This study is a follow-up prospective validation study conducted from January 2019 to April 2021. A total of 410 advanced cancer patients who presented to the ED of a medical centre and could be followed-up feasibly were recruited. Univariate and multivariable logistic regression analyses were performed with receiver operator calibrating (ROC) curve analysis. Non-survivors had significantly lower body temperatures, higher pulse rates, higher respiratory rates, lower blood pressures, and higher SI. Each 0.1 increment of SI increased the odds of 60-day mortality by 1.591. Area under ROC curve was 0.7819. At optimal cut-off of 0.94, SI had 66.10% accuracy. These results were similar to our previous study, thus validating the use of SI in predicting the 60-day mortality of advanced cancer patients presenting to the ED. Identified patients may be offered palliative care.
预计生存期不超过短期的晚期癌症患者可从急诊科（ED）早期启动姑息治疗中获益。然而，这种讨论需要对他们的短期生存进行准确的预后评估。我们之前在回顾性研究中发现，休克指数（SI）是预测到急诊科就诊的晚期癌症患者60天死亡风险的理想风险分层工具。本研究是一项于2019年1月至2021年4月进行的前瞻性验证随访研究。共招募了410名到某医疗中心急诊科就诊且可进行可行随访的晚期癌症患者。进行了单变量和多变量逻辑回归分析，并进行了受试者操作校准（ROC）曲线分析。未存活者的体温显著更低、脉搏率更高、呼吸频率更高、血压更低且休克指数更高。休克指数每增加0.1，60天死亡几率增加1.591。ROC曲线下面积为0.7819。在最佳截断值为0.94时，休克指数的准确率为66.10%。这些结果与我们之前的研究相似，从而验证了休克指数在预测到急诊科就诊的晚期癌症患者60天死亡率方面的应用。可向识别出的患者提供姑息治疗。
