Laura Sofia Cardelli, Lorenzo Gamberini, Beatrice Dal Passo, Silvia Zagnoni, Francesca Sciarra, Federica Frascaro, Alice Vitagliano, Valeria Carinci, Maria Laura Canale, Gianni Casella
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This study evaluates the PPS as a prognostic tool for in-hospital and 1-year all-cause mortality in CICU patients.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>The PPS is a reliable and independent predictor of mortality in CICU patients. 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引用次数: 0
摘要
背景:人口老龄化导致慢性疾病的患病率增加,对患有多种合并症的危重心脏病患者的管理提出了挑战。缓和表现量表(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(CICUs)的研究仍未充分。本研究评估PPS作为一种预测住院和1年全因死亡率的工具。方法:我们在博洛尼亚的Maggiore医院进行了一项单中心、前瞻性、观察性研究,包括在2022年8月至2023年11月期间入住CICU的1131例患者。根据患者入院时PPS评分(≤70和bbb70)将患者分为两组。采用多变量回归模型评估死亡率预测因子,生成Kaplan-Meier生存曲线。采用受试者工作特性曲线和Hosmer-Lemeshow检验评估模型精度和校准。结果:PPS≤70的患者1年全因死亡率显著增高(37.0% vs 9.8%)。结论:PPS是一种可靠且独立的预测CICU患者死亡率的指标。将PPS纳入临床实践可以加强高危人群的风险分层、指导决策和优化资源配置。
Palliative Performance Scale predicts mortality in cardiac intensive care unit.
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
期刊介绍:
Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.