Using Laboratory Test Results at Hospital Admission to Predict Short-term Survival in Critically Ill Patients With Metastatic or Advanced Cancer.

Abstract

Accurately estimating the life expectancy of critically ill patients with metastatic or advanced cancer is a crucial step in planning appropriate palliative or supportive care. We evaluated the results of laboratory tests performed within two days of hospital admission to predict the likelihood of death within 14 days. We retrospectively selected patients 18 years or older with metastatic or advanced cancer who were admitted to intensive care units or palliative and supportive care services in our hospital. We evaluated whether the following are independent predictors in a logistic regression model: age, sex, comorbidities, and the results of seven commonly available laboratory tests. The end point was death within 14 days in or out of the hospital. Of 901 patients in the development cohort and 45% died within 14 days. The risk of death within 14 days after admission increased with increasing age, lactate dehydrogenase levels, and white blood cell counts and decreasing albumin levels and platelet counts (P < 0.01). The model predictions were confirmed using a separate validation cohort. The areas under the receiver operating characteristic curves were 0.74 and 0.70 for the development and validation cohorts, respectively, indicating good discriminatory ability for the model. Our results suggest that laboratory test results performed within two days of admission are valuable in predicting death within 14 days for patients with metastatic or advanced cancer. Such results may provide an objective assessment tool for physicians and help them initiate conversations with patients and families about end-of-life care.