Roberts Rhiannon L, Imsirovic Haris, Talarico Robert, Li Wenshan, Carrington André, Patel Kruti, Manuel Douglas, Tanuseputro Peter, Hawken Steven, Webber Colleen
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa.
ICES uOttawa, Ottawa.
Can Geriatr J. 2025 Mar 1;28(1):73-86. doi: 10.5770/cgj.28.808. eCollection 2025 Mar.
As individuals approach death, they experience declines in their cognitive, physical, motor, sensory, physiologic, and psychosocial functions. In this exploratory study we examined individuals' physiologic changes in the last year of life by examining laboratory tests commonly used in clinical practice.
Using health administrative datasets, we conducted an observational matched cohort study to assess laboratory test use and values over a decedent's last 12 months and a matched observation window for non-decedents. Laboratory tests included tests for electrolytes: potassium and sodium; complete blood count: hemoglobin and leukocytes; diabetes: hemoglobin A1c; and kidney or liver function: albumin-serum, alanine aminotransferase, and creatinine.
We identified 376,463 decedents, 367,474 (97.6%) of whom were matched to non-decedents (similar age and sex). For each test, the proportion of non-decedents who received the test was stable over the 12-month observation period. A higher proportion of decedents had a laboratory test than non-decedents for all but the diabetes test. As decedents neared death, there was a gradual increase in test use until their final month of life, when test use dramatically increased. Across all laboratory tests, test values remained similar for non-decedents over the 12-month observation period. However, for decedents, there were differences in the magnitude and direction of the test values over the 12 months.
Our findings indicate distinct changes in decedents' laboratory test use and values over their last 12 months. Future work should explore whether laboratory tests could predict survival or improve the performance of mortality prediction models.
随着个体临近死亡，他们的认知、身体、运动、感官、生理和心理社会功能会出现衰退。在这项探索性研究中，我们通过检查临床实践中常用的实验室检测来研究个体在生命最后一年的生理变化。
利用卫生行政数据集，我们进行了一项观察性匹配队列研究，以评估死者最后12个月的实验室检测使用情况和检测值，并为非死者设置了一个匹配的观察窗口。实验室检测包括电解质检测：钾和钠；全血细胞计数：血红蛋白和白细胞；糖尿病检测：糖化血红蛋白；以及肾脏或肝功能检测：血清白蛋白、丙氨酸转氨酶和肌酐。
我们识别出376,463名死者，其中367,474名（97.6%）与非死者（年龄和性别相似）进行了匹配。对于每项检测，在12个月的观察期内，接受检测的非死者比例保持稳定。除糖尿病检测外，所有检测中死者接受实验室检测的比例均高于非死者。随着死者临近死亡，检测使用逐渐增加，直至生命的最后一个月，检测使用量急剧上升。在所有实验室检测中，非死者在12个月观察期内的检测值保持相似。然而，对于死者，在12个月内检测值的幅度和方向存在差异。
我们的研究结果表明，死者在生命最后12个月的实验室检测使用情况和检测值存在明显变化。未来的工作应探索实验室检测是否能够预测生存或改善死亡率预测模型的性能。
