Clinical Study

Palliative Prognostic Index accuracy of survival prediction in an inpatient palliative care service at a Brazilian tertiary hospital

11 May 2021
Mauricio Fernandes, Tiago Pugliese Branco, Maria Clara Navarro Fernandez, Carolina Paparelli, Mariana Sarkis Braz, Carolina Sassaki Kishimoto, Helena Maria de Freitas Medeiros, Karen Ebina, Luciana Regina Bertini Cabral, Simone Nagashima, Silvia Amaral de Avó Cortizo, Fabíola Borges, Mariana Ribeiro Monteiro, Ana Beatriz Kinupe Abrahao, Raphael Brandão Moreira, Alze Pereira dos Santos Tavares, Pedro Nazareth Aguiar Jr

Purpose: The Palliative Prognostic Index (PPI) was developed to improve survival prediction for advanced cancer patients. However, there is limited data about the PPI application in a real-world scenario. This study aimed to assess the accuracy of PPI > 6 in predicting survival of cancer inpatients.

Methods: A prospective observational cohort in an inpatient palliative care service at a tertiary hospital in São Paulo-SP, Brazil, between May 2011 and December 2018.

Results: We included 1,376 critically ill cancer inpatients. Patients were divided into three PPI subgroups: PPI ≤ 4, PPI 4–6, and PPI ≥ 6. Their respective medium overall survival values were 44 days (95% confidence interval [CI] 35.52–52.47), 20 days (95% CI 15.40–24.59), and 8 days (95% CI 7.02–8.98), (p < 0.001). PPI ≥ 6 predicted survival of <3 weeks with a positive predictive value (PPV) of 72% and an negative predictive value (NPV) of 68% (sensitivity 67%, specificity 72%). PPI > 4 predicted survival of <6 weeks with a PPV of 88% and an NPV of 36% (sensitivity 74%, specificity 59%). When PPI was <4, the mortality rate over 3 weeks was 39% with a relative risk (RR) of 0.15 (95% CI 0.11–0.20; p < 0.001), and the 6-week mortality rate was 63% with a RR of 0.18 (95% CI 0.13–0.25; p < 0.001) compared to PPI ≥ 4.

Conclusions: PPI was a good discriminator of survival among critically ill cancer inpatients and could assist in hospital discharge decision. PPI may help healthcare policymakers and professionals in offering high-quality palliative care to patients.