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Development and internal validation of laboratory prognostic score to predict 14-day mortality in terminally ill patients with gastrointestinal malignancy

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Abstract

Background

Few studies have developed an easy scoring system for the short-term survival of patients with gastrointestinal (GI) malignancy.

Methods

A total of 816 terminally ill patients with GI malignancy were admitted to our palliative care unit. They were randomly divided into the investigation (n = 490) and validation (n = 326) groups. A total of 19 laboratory blood parameters were analyzed. Receiver-operating characteristic analysis was performed for each blood factor, and the area under the curve was calculated to determine the predictive value for 14-day survival after the blood test. Multivariable logistic regression analysis was performed to identify significant independent prognostic factors for 14-day mortality. To develop a scoring system for 14-day mortality, the laboratory prognostic score for gastrointestinal malignancy (GI-LPS) was calculated using the sum of indices of the independent prognostic factors.

Results

Multivariable analysis showed that 5 of 19 indices, namely total bilirubin ≥ 2.1 mg/dL, blood urea nitrogen ≥ 28 mg/dL, eosinophil percentage ≤ 0.5%, neutrophil-to-lymphocyte ratio ≥ 9.2, and platelet count ≤ 194 × 103/μL, were significant independent factors of 14-day survival. GI-LPS showed acceptable accuracy for 14-day mortality in the investigation and validation groups. GI-LPS 3 (including any three factors) predicted death within 14 days, with a sensitivity of 56–58%, a specificity of 82–87%, a positive predictive value of 48–50%, and a negative predictive value of 87–90%.

Conclusions

GI-LPS showed an acceptable ability to predict 14-day survival and can provide additional information to conventional prognostic scores.

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Funding

This work was supported by the Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital Research Grant. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan

    Hidemasa Nagai & Norihiro Yuasa

  2. Department of Palliative Medicine, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan

    Natsuko Kawai & Norihiro Yuasa

Authors
  1. Hidemasa Nagai
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  3. Norihiro Yuasa
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by HN, NK, and NY. The first draft of the manuscript was written by HN and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Norihiro Yuasa.

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Ethics approval and consent to participate

The study protocol was approved by the Institutional Review Board of our hospital (approval reference number: 2018–195). The Institutional Review Board of our hospital (approval reference number: 2018–195) waived the requirement for informed consent owing to the retrospective nature of the study.

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Not applicable.

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The authors declare no competing interests.

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Nagai, H., Kawai, N. & Yuasa, N. Development and internal validation of laboratory prognostic score to predict 14-day mortality in terminally ill patients with gastrointestinal malignancy. Support Care Cancer 30, 4179–4187 (2022). https://doi.org/10.1007/s00520-021-06746-0

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  • DOI: https://doi.org/10.1007/s00520-021-06746-0

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