緩和ケアと医学

抽象的な

Predictors of Seven-Day Mortality in Patients with Advanced Oncologic Liver Disease Admitted to a Palliative Care Unit

Nathalie Rahm, Audrey Calmant and Christophe Combescure

Context and objectives: A specific prognostic tool is lacking for end-stage oncological liver diseases. In addition to various factors, bilirubin, which reflects the severity of liver dysfunction, may be associated with mortality in this population. We aimed to assess how bilirubin influence survival in patients admitted in palliative care units with advanced oncologic liver diseases and to develop a prognostic model combining bilirubin with other factors. Methods: Data were collected retrospectively from 652 patients with oncologic liver diseases, accounting for 25% of all admissions in our palliative care units from 2011 to 2016. Age, gender, chronic liver diseases, infections including spontaneous bacterial peritonitis, gastrointestinal bleeding, encephalopathy, Eastern Cooperative Oncology Group score (ECOG), oral intake, jaundice, dyspnea, bilirubin, albumin and urea variables collected within 24 hours before or after admission were analyzed. Univariate and multivariate survival analyses were performed to identify the predictive value of bilirubin and other variables for 7-day survival. Results: Bilirubin value was collected in 398 patients. Univariate analysis showed that male sex, chronic liver diseases, encephalopathy, ECOG, oral intake, jaundice, bilirubin and urea blood levels, were associated with 7-day survival. Multivariate analysis showed that bilirubin>25 μ mol/L, urea>15 mmol/L, ECOG=4 and reduced oral intake, were independently correlated with survival. Accuracy of the model based on these factors to predict 7-day mortality is high (AUC=0.90). Conclusion: Bilirubin is an independent prognostic factor for 7 day-survival among patients with end-stage oncologic liver disease. Combining bilirubin, urea, ECOG and oral intake increases short term prognostication accuracy in this subgroup of patients.