Cardelli Laura Sofia, Gamberini Lorenzo, Dal Passo Beatrice, Zagnoni Silvia, Sciarra Francesca, Frascaro Federica, Vitagliano Alice, Carinci Valeria, Canale Maria Laura, Casella Gianni
Cardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy
Cardiology Department, Ospedale Versilia, Lido di Camaiore, Toscana, Italy.
Open Heart. 2025 Jun 27;12(1):e003302. doi: 10.1136/openhrt-2025-003302.
The ageing population has led to an increased prevalence of chronic diseases, posing challenges for the management of critically ill cardiac patients with multiple comorbidities. The Palliative Performance Scale (PPS), initially developed for terminally ill cancer patients, has shown prognostic value in various medical settings but remains understudied in cardiac intensive care units (CICUs). This study evaluates the PPS as a prognostic tool for in-hospital and 1-year all-cause mortality in CICU patients.
We conducted a single-centre, prospective, observational study at the Maggiore Hospital in Bologna, including 1131 patients admitted to the CICU between August 2022 and November 2023. Patients were stratified into two groups based on their PPS at admission (≤70 and >70). Multivariable regression models were used to assess predictors of mortality, and Kaplan-Meier survival curves were generated. Model accuracy and calibration were evaluated using receiver operating characteristic curves and the Hosmer-Lemeshow test.
Patients with PPS ≤70 had significantly higher 1-year all-cause mortality (37.0% vs 9.8%, p<0.001) and in-hospital all-cause mortality (17.7% vs 3.3%, p<0.001). In the multivariable regression models, PPS emerged as an independent predictor of both 1-year and in-hospital all-cause mortality, along with age and Sequential Organ Failure Assessment score. The models demonstrated good discriminatory performance (area under the curve of 0.841 for 1-year mortality, 0.862 for in-hospital mortality) and acceptable calibration.
The PPS is a reliable and independent predictor of mortality in CICU patients. Incorporating PPS into clinical practice may enhance risk stratification, guide decision-making and optimise resource allocation in this high-risk population.
人口老龄化导致慢性病患病率上升，给患有多种合并症的危重心脏病患者的管理带来了挑战。姑息治疗表现量表（PPS）最初是为晚期癌症患者开发的，已在各种医疗环境中显示出预后价值，但在心脏重症监护病房（CICU）中仍未得到充分研究。本研究评估PPS作为CICU患者院内及1年全因死亡率的预后工具。
我们在博洛尼亚的马焦雷医院进行了一项单中心、前瞻性观察性研究，纳入了2022年8月至2023年11月期间入住CICU的1131例患者。根据入院时的PPS将患者分为两组（≤70和>70）。使用多变量回归模型评估死亡率的预测因素，并生成Kaplan-Meier生存曲线。使用受试者工作特征曲线和Hosmer-Lemeshow检验评估模型的准确性和校准情况。
PPS≤70的患者1年全因死亡率（37.0%对9.8%，p<0.001）和院内全因死亡率（17.7%对3.3%，p<0.001）显著更高。在多变量回归模型中，PPS与年龄和序贯器官衰竭评估评分一起，成为1年和院内全因死亡率的独立预测因素。模型显示出良好的区分性能（1年死亡率曲线下面积为0.841，院内死亡率曲线下面积为0.862）和可接受的校准。
PPS是CICU患者死亡率的可靠且独立的预测因素。将PPS纳入临床实践可能会加强这一高危人群的风险分层，指导决策并优化资源分配。
