000130838 001__ 130838
000130838 005__ 20240131210811.0
000130838 0247_ $$2doi$$a10.1016/j.jpainsymman.2013.04.011
000130838 0248_ $$2sideral$$a86462
000130838 037__ $$aART-2014-86462
000130838 041__ $$aeng
000130838 100__ $$aBernabeu-Wittel, M.
000130838 245__ $$aDevelopment of a six-month prognostic index in patients with advanced chronic medical conditions: The PALIAR score
000130838 260__ $$c2014
000130838 5060_ $$aAccess copy available to the general public$$fUnrestricted
000130838 5203_ $$aContext
Efforts in developing useful tools to properly identify the end-of-life trajectory of patients with advanced medical diseases have been made, but the calibration and/or discriminative power of these tools has not been optimal.
Objectives
Our objective was to develop a new, reliable prognostic tool to identify the probability of death within six months in patients with chronic medical diseases.
Methods
This was a multicenter, prospective, observational study in 41 Spanish hospitals, which included 1778 patients with one or more of the following: advanced conditions such as heart failure, respiratory failure, chronic renal failure, chronic liver disease, and/or chronic neurological disease. All patients were followed over six months. Each factor independently associated with death in the derivation cohort (884 patients from eastern areas of Spain) was assigned a prognostic weight, and the score was calculated by summing up the factors. The score's accuracy in the validation cohort (894 patients from western areas of Spain) was assessed by analyzing its calibration and discriminative power; we also calculated sensitivity, specificity, and positive and negative predictive values.
Results
Mortality in the derivation/validation cohorts was 37.6%/37.7%, respectively. We identified six independent predictors of mortality (≥85 years, three points; New York Heart Association Class IV/Stage 4 dyspnea on the modified Medical Research Council, 3.5 points; anorexia, 3.5 points; presence of pressure ulcer(s), three points; Eastern Cooperative Oncology Group Performance Status of three or more, four points; and albuminemia ≤2.5 g/dL, four points). Mortality in the derivation/validation cohorts according to risk group was 20%/21.5% for patients with zero points; 33%/30.5% for those with 3–3.5 points; 46.3%/43% for those with four to seven points; and 67%/61% for those who reached 7.5 or more points, respectively. The calibration was good (Hosmer-Lemeshow test, P = 0.39), as was the discriminative power (area under the receiver operating characteristic curve of 0.69 [0.66–0.72]). The sensitivity (85%), specificity (86%), positive and negative predictive values (64% and 80%, respectively) at 180 days were high.
Conclusion
The PALIAR score is a precise and reliable tool for identifying the end-of-life trajectory in patients with advanced medical diseases.
000130838 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc-nd$$uhttp://creativecommons.org/licenses/by-nc-nd/3.0/es/
000130838 590__ $$a2.795$$b2014
000130838 591__ $$aHEALTH CARE SCIENCES & SERVICES$$b19 / 87 = 0.218$$c2014$$dQ1$$eT1
000130838 591__ $$aMEDICINE, GENERAL & INTERNAL$$b28 / 154 = 0.182$$c2014$$dQ1$$eT1
000130838 591__ $$aCLINICAL NEUROLOGY$$b70 / 191 = 0.366$$c2014$$dQ2$$eT2
000130838 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000130838 700__ $$aMurcia-Zaragoza, J.
000130838 700__ $$aHernández-Quiles, C.
000130838 700__ $$aEscolano-Fernández, B.
000130838 700__ $$aJarava-Rol, G.
000130838 700__ $$aOliver, M.
000130838 700__ $$0(orcid)0000-0002-3132-2171$$aDíez-Manglano, Jesús$$uUniversidad de Zaragoza
000130838 700__ $$aRuiz-Cantero, A.
000130838 700__ $$aOllero-Baturone, M.
000130838 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000130838 773__ $$g47, 3 (2014), 551-565$$pJ. Pain Symptom Manage.$$tJOURNAL OF PAIN AND SYMPTOM MANAGEMENT$$x0885-3924
000130838 8564_ $$s627388$$uhttps://zaguan.unizar.es/record/130838/files/texto_completo.pdf$$yVersión publicada
000130838 8564_ $$s1947949$$uhttps://zaguan.unizar.es/record/130838/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000130838 909CO $$ooai:zaguan.unizar.es:130838$$particulos$$pdriver
000130838 951__ $$a2024-01-31-19:24:54
000130838 980__ $$aARTICLE