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Palliative Prognostic Index as a predictor of mortality among geriatric patients with advanced chronic medical conditions

Introduction: This study is to validate Palliative Prognostic Index (PPI) as a tool for six months prognostication in geriatric patients with advanced chronic medical conditions and to identify other independent prognostic markers of survival. Methods: This was a prospective and observational stud...

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Main Authors: Affizal, Samsudin, Yon Lek, Yap, Yoon Doong, Loh, Htwe Chit, Htwe, Mohamad Adam, Bujang
Format: Article
Language:English
Published: Malaysian Medical Association 2022
Subjects:
R Medicine (General)
Online Access:http://ir.unimas.my/id/eprint/39001/1/Palliative%20Prognostic%20-%20Copy.pdf
http://ir.unimas.my/id/eprint/39001/
http://www.e-mjm.org/index.html
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spelling my.unimas.ir.390012022-08-01T02:54:05Z http://ir.unimas.my/id/eprint/39001/ Palliative Prognostic Index as a predictor of mortality among geriatric patients with advanced chronic medical conditions Affizal, Samsudin Yon Lek, Yap Yoon Doong, Loh Htwe Chit, Htwe Mohamad Adam, Bujang R Medicine (General) Introduction: This study is to validate Palliative Prognostic Index (PPI) as a tool for six months prognostication in geriatric patients with advanced chronic medical conditions and to identify other independent prognostic markers of survival. Methods: This was a prospective and observational study of 108 geriatric patients conducted at Pusat Jantung Hospital Umum Sarawak (PJHUS) Kota Samarahan and Sarawak General Hospital (SGH). The PPI scores were calculated and determined at the time of admission. Mortality is considered as the primary outcome. Sensitivity and specificity analysis were conducted to test the accuracy of PPI. The ideal cut-off value for PPI and other associated markers were determined based on the highest value of Youden Index. Cox regression analysis and survival analysis were applied to test the association between potential markers within six months. Results: PPI score has a significant association with survival within six months based on univariate and multivariate analyses (p<0.05). Total PPI had a hazard ratio of 1.56 (95% Confidence Interval (95%CI): 1.33,1.57). The study shows PPI reported area under the curve-ROC of 0.945 with p<0.001. PPI score with cut-off value of six reports the highest accuracy in predicting death within six months with sensitivity and specificity of 88.6% and 90.6%, respectively. Total PPI score of >6 with serum albumin level ≤25, the sensitivity and specificity tested were 100.0%. Conclusion: PPI has the potential to be a useful and significant predictor of mortality within six months in the geriatric population with an advanced chronic medical condition. This study also re-emphasised the strong prognostic role of other markers such as Palliative Performance Scale, Barthel Index, and serum albumin level. This study has identified that hypoalbuminemia cut-off value of 25g/dL analysed against PPI score of >5 revealed extremely high accuracy of prognostication for mortality. Malaysian Medical Association 2022 Article PeerReviewed text en http://ir.unimas.my/id/eprint/39001/1/Palliative%20Prognostic%20-%20Copy.pdf Affizal, Samsudin and Yon Lek, Yap and Yoon Doong, Loh and Htwe Chit, Htwe and Mohamad Adam, Bujang (2022) Palliative Prognostic Index as a predictor of mortality among geriatric patients with advanced chronic medical conditions. Medical Journal of Malaysia, 77 (4). pp. 468-473. ISSN 0300-5283 http://www.e-mjm.org/index.html
institution Universiti Malaysia Sarawak
building Centre for Academic Information Services (CAIS)
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaysia Sarawak
content_source UNIMAS Institutional Repository
url_provider http://ir.unimas.my/
language English
topic R Medicine (General)
spellingShingle R Medicine (General)
Affizal, Samsudin
Yon Lek, Yap
Yoon Doong, Loh
Htwe Chit, Htwe
Mohamad Adam, Bujang
Palliative Prognostic Index as a predictor of mortality among geriatric patients with advanced chronic medical conditions
description Introduction: This study is to validate Palliative Prognostic Index (PPI) as a tool for six months prognostication in geriatric patients with advanced chronic medical conditions and to identify other independent prognostic markers of survival. Methods: This was a prospective and observational study of 108 geriatric patients conducted at Pusat Jantung Hospital Umum Sarawak (PJHUS) Kota Samarahan and Sarawak General Hospital (SGH). The PPI scores were calculated and determined at the time of admission. Mortality is considered as the primary outcome. Sensitivity and specificity analysis were conducted to test the accuracy of PPI. The ideal cut-off value for PPI and other associated markers were determined based on the highest value of Youden Index. Cox regression analysis and survival analysis were applied to test the association between potential markers within six months. Results: PPI score has a significant association with survival within six months based on univariate and multivariate analyses (p<0.05). Total PPI had a hazard ratio of 1.56 (95% Confidence Interval (95%CI): 1.33,1.57). The study shows PPI reported area under the curve-ROC of 0.945 with p<0.001. PPI score with cut-off value of six reports the highest accuracy in predicting death within six months with sensitivity and specificity of 88.6% and 90.6%, respectively. Total PPI score of >6 with serum albumin level ≤25, the sensitivity and specificity tested were 100.0%. Conclusion: PPI has the potential to be a useful and significant predictor of mortality within six months in the geriatric population with an advanced chronic medical condition. This study also re-emphasised the strong prognostic role of other markers such as Palliative Performance Scale, Barthel Index, and serum albumin level. This study has identified that hypoalbuminemia cut-off value of 25g/dL analysed against PPI score of >5 revealed extremely high accuracy of prognostication for mortality.
format Article
author Affizal, Samsudin
Yon Lek, Yap
Yoon Doong, Loh
Htwe Chit, Htwe
Mohamad Adam, Bujang
author_facet Affizal, Samsudin
Yon Lek, Yap
Yoon Doong, Loh
Htwe Chit, Htwe
Mohamad Adam, Bujang
author_sort Affizal, Samsudin
title Palliative Prognostic Index as a predictor of mortality among geriatric patients with advanced chronic medical conditions
title_short Palliative Prognostic Index as a predictor of mortality among geriatric patients with advanced chronic medical conditions
title_full Palliative Prognostic Index as a predictor of mortality among geriatric patients with advanced chronic medical conditions
title_fullStr Palliative Prognostic Index as a predictor of mortality among geriatric patients with advanced chronic medical conditions
title_full_unstemmed Palliative Prognostic Index as a predictor of mortality among geriatric patients with advanced chronic medical conditions
title_sort palliative prognostic index as a predictor of mortality among geriatric patients with advanced chronic medical conditions
publisher Malaysian Medical Association
publishDate 2022
url http://ir.unimas.my/id/eprint/39001/1/Palliative%20Prognostic%20-%20Copy.pdf
http://ir.unimas.my/id/eprint/39001/
http://www.e-mjm.org/index.html
_version_ 1740829584541089792
score 13.211869

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