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The application of the palliative prognostic index in predicting the life expectancy of patients in palliative care: a systematic review and meta-analysis

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Abstract

Background

The palliative prognostic index (PPI) is a commonly used tool to predict the life expectancy in palliative care patients. However, there is no universal cutoff, and the accuracy of different cutoffs varies. Therefore, we conducted this meta-analysis to explore the validity and accuracy of different PPI scores for different survival time in palliative care setting.

Methods

PubMed, Embase, Cochrane, Scopus and Chinese CNKI databases were searched to identify studies using the PPI as a prognostic tool to predict survival time in palliative care. We calculated pooled hazard ratios (HRs) with corresponding 95% confidence intervals (CIs), and subgroup analyses were also conducted by different cutoffs. After extracting data, we estimated the pooled sensitivity, specificity, positive predictive value, and negative predictive value.

Results

We identified 15 studies with 7455 assessments. Seven of these studies were synthesized for a combined HR. The pooled HR was 1.94 (95% CI 1.54–2.44) when cutoffs were 2 and 4, and 2.34 (95% CI 1.50–3.66) when cutoffs were 4 and 6. Of all the studies, 13 studies reported their accuracy, of which four studies were assessed by meta-analysis. The sensitivity of the PPI for 3-week survival ranged from 51 to 92% and specificity ranged from 60.0 to 94.0%, respectively. The sensitivity and specificity of the PPI for 6-week survival were from 46.0 to 89.1% and from 51.7 to 84.4%, respectively. The pooled sensitivity and specificity of the PPI for 3-week survival were 68% (6 as cutoff) and 76% (6 as cutoff), respectively. As for 6-week survival prediction, the pooled sensitivity and specificity were 68% (4 as cutoff) and 82% (4 as cutoff), respectively.

Conclusion

The PPI is a useful prognosticator of life expectancy of patients in palliative care, especially for patients with short survival time. However, there were no universal cutoff, and the predicted life span varies. Our data eliminated that using 4 and 6 as cutoffs can better predict the patients’ survival time for 3 or 6 weeks. Due to small number of studies and poor qualities of them, result may alter as more studies with better quality are enrolled in the future.

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Acknowledgements

The authors thank the staff of the Department of Geriatrics Medicine, West China Hospital, for their guidance and support.

Funding

No funding was received for this article.

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Author notes

  1. Ying Liu and Lin Su are co-first author.

Authors and Affiliations

  1. The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, China

    Ying Liu, Lin Su, Yuting Wang, Shuang Liu & Birong Dong

  2. National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, China

    Ying Liu, Lin Su, Yuting Wang, Shuang Liu & Birong Dong

Authors
  1. Ying Liu
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  2. Lin Su
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  3. Yuting Wang
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  4. Shuang Liu
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  5. Birong Dong
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Contributions

YL formulated the research question, designed the study and screened the articles, collected the data, assessed the quality of studies and drafted the manuscript. LS designed the study and revised the manuscript. YW collected the data and analyzed the data. SL screened the articles and assessed the qualities of studies. BD assisted with formulating the research question and supervising the quality of the paper.

Corresponding author

Correspondence to Birong Dong.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Cite this article

Liu, Y., Su, L., Wang, Y. et al. The application of the palliative prognostic index in predicting the life expectancy of patients in palliative care: a systematic review and meta-analysis. Aging Clin Exp Res 30, 1417–1428 (2018). https://doi.org/10.1007/s40520-018-0928-7

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  • DOI: https://doi.org/10.1007/s40520-018-0928-7

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