探讨改良的住院患者一年死亡率评分在触发癌症住院患者转介姑息治疗中的作用。
Exploring the Utility of the Modified Hospitalized-Patient One-Year Mortality Risk Score to Trigger Referrals to Palliative Care for Inpatients With Cancer.
机构信息
Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Department of Medicine, Division of Palliative Medicine, University of Toronto, Toronto, Ontario, Canada.
出版信息
Cancer Med. 2024 Oct;13(19):e70292. doi: 10.1002/cam4.70292.
BACKGROUND
Estimating prognosis can be a barrier to timely palliative care involvement. The modified Hospitalized-patient One-year Mortality Risk (mHOMR) score uses hospital admission data to calculate the risk of death within 12 months and may be a useful tool to trigger a referral to palliative care.
METHODS
The mHOMR tool was retrospectively applied to consecutive acute admissions to a quaternary cancer center in Toronto, Canada from March 1 to May 31, 2018. The study aimed to investigate the association between dichotomized mHOMR scores (the cohort median score of 0.27 and the developer-recommended score of 0.21) and the risk of death, and whether these could be used to identify patients who may benefit from timely palliative care involvement.
RESULTS
Of 269 inpatients, 87 were elective admissions and excluded from further analyses. At the median mHOMR score of 0.27, 91/182 patients (50%) were categorized as high-risk of death within 12 months (mHOMR+), 53 (58%) were referred to palliative care. At the lower cut-off of 0.21, 103 patients were mHOMR+, of whom 57 (55.3%) were referred to palliative care. The higher mHOMR was significantly associated with mortality (29.7% mHOMR- vs. 39.8% mHOMR+ at 12 months, log-rank p < 0.05). The association between the developer-recommended mHOMR cut-off (≥ 0.21) and mortality was not significant (p = 0.15).
CONCLUSIONS
A higher mHOMR score was significantly associated with the risk of mortality in patients with advanced cancer. However, the developer-recommended mHOMR cut-off of 0.21 failed to identify a statistically significant difference between patients with advanced cancer at low versus high scores. While mHOMR may be a useful tool to augment clinical judgment and identify inpatients with advanced cancer at high risk of death, who in turn may benefit from referral to palliative care, the optimal mHOMR cutoff may warrant adjustment for this population.
背景
评估预后可能会成为及时提供姑息治疗的障碍。改良住院患者一年死亡率风险（mHOMR）评分利用住院数据来计算 12 个月内死亡的风险，可能是触发向姑息治疗转介的有用工具。
方法
该 mHOMR 工具被回顾性地应用于 2018 年 3 月 1 日至 5 月 31 日期间在加拿大多伦多的一家四级癌症中心连续收治的急性住院患者。本研究旨在探讨二分法 mHOMR 评分（队列中位数 0.27 和开发者推荐的评分 0.21）与死亡风险之间的关系，以及它们是否可以用于识别可能受益于及时姑息治疗的患者。
结果
在 269 名住院患者中，87 名是择期入院的患者，因此被排除在进一步的分析之外。在中位数 mHOMR 评分为 0.27 时，182 名患者中有 91 名（50%）被归类为 12 个月内死亡风险高（mHOMR+），53 名（58%）被转介到姑息治疗。在较低的截断值 0.21 时，103 名患者 mHOMR+，其中 57 名（55.3%）被转介到姑息治疗。较高的 mHOMR 与死亡率显著相关（mHOMR-在 12 个月时为 29.7%，mHOMR+为 39.8%，对数秩检验 p<0.05）。与开发者推荐的 mHOMR 截断值（≥0.21）与死亡率之间的关联无统计学意义（p=0.15）。
结论
较高的 mHOMR 评分与晚期癌症患者的死亡风险显著相关。然而，开发者推荐的 mHOMR 截断值 0.21 未能在低评分和高评分的晚期癌症患者之间识别出统计学上的显著差异。虽然 mHOMR 可能是一种有用的工具，可以增强临床判断，并识别出死亡风险高的晚期癌症住院患者，而这些患者可能受益于姑息治疗的转介，但最佳的 mHOMR 截断值可能需要为此人群进行调整。
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