• Masanori Mori, Henrique A Parsons, Maxine De la Cruz, Ahmed Elsayem, Shana L Palla, Jun Liu, Zhijun Li, Lynn Palmer, Eduardo Bruera, and Nada A Fadul.
• Division of Hematology and Oncology, Fletcher Allen Health Care/University of Vermont College of Medicine, Burlington, Vermont, USA.
• J Palliat Med. 2011 Sep 1;14(9):1034-41.

ContextAlthough several symptoms have been shown to predict survival, little is known of the roles of symptom changes in predicting inpatient death.ObjectivesTo determine the association between changes in symptoms and inpatient mortality among advanced cancer patients in an acute palliative care unit (APCU).MethodsWe retrospectively reviewed the medical records of 166 consecutive cancer patients admitted to our APCU from the emergency center (EC) or clinic from June 2006 to December 2007. We recorded symptom severity and presence of delirium on admission (baseline) and on the third, fourth, or fifthth day, whichever appeared first (follow-up). The primary endpoint was the vital status at discharge. Univariate (UVA) and multivariate analyses (MVA) were used to estimate the odds of inpatient death.ResultsOne hundred and thirty-four patients (80.7%) were discharged alive and 32 (19.3%) died in the APCU. All symptoms significantly improved at follow-up. In UVA, persistent delirium was significantly associated with inpatient mortality (odds ratio [OR] 2.59, 95% confidence interval [CI 1] 0.09-6.17, p = 0.031), although presence of baseline delirium was not. MVA revealed that greater risk of dying was jointly correlated with a high level of baseline dyspnea (OR 1.35, 95% CI 1.13-1.61, p = 0.001) and drowsiness (OR 1.25, 95% CI 1.04-1.50, p = 0.02), low level of baseline anxiety (OR 0.83, 95% CI 0.70-0.99, p = 0.038), and transfer from EC (OR 6.78, 95% CI 1.99-23.14, p = 0.002). Worsened depression was significantly related with death in UVA (OR 1.30, 95% CI 1.08-1.56, p < 0.001), but not in MVA.ConclusionChanges in certain symptoms, such as worsened depression and persistent delirium, might be important predictors of inpatient death.

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