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Accuracy of prognosis prediction by PPI in hospice inpatients with cancer: a multi-centre prospective study
  1. Sivakumar Subramaniam1,
  2. Andrew Thorns2,
  3. Martin Ridout3,
  4. Thiru Thirukkumaran2 and
  5. Thomas Richard Osborne4
  1. 1EllenorLions Hospice, Gravesend, UK
  2. 2Department of Palliative Medicine, Pilgrims Hospices/University of Kent, Canterbury, East Kent, UK
  3. 3Department of Statistics, University of Kent, Canterbury, Kent, UK
  4. 4Departments of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
  1. Correspondence to Dr Sivakumar Subramaniam, Pilgrims Hospice, Canterbury, Kent CT2 8JA, UK; drsivakumar{at}


The Palliative Prognostic Index (PPI) is a prognostication tool for palliative care patients based on clinical indices developed in Japan and further validated by one study in the UK. The aim of this study was to test its prediction accuracy in a large inpatient hospice sample. The admitting doctor in three inpatient hospices calculated the PPI score on admission. Two hundred and sixty-two patients were included in this study. Based on the PPI score, three subgroups were identified. Group 1 corresponded to patients with PPI ≤4 and the median survival of 53 days (95% CI 40 to 80 days). Group 2 corresponded to those with PPI >4 and ≤6 and the median survival 15 days (95% CI 12 to 26 days) and Group 3 corresponded to patients with PPI >6 and the median survival of 5 days (95% CI 3 to 7 days). In this study, PPI was able to identify patients’ likelihood of dying within 3 weeks with a sensitivity of 64% and specificity of 83%. It was able to identify a 6-week survival chance with a sensitivity of 62% and specificity of 86%. A one-unit increase in PPI score was estimated to increase the hazard for death by a factor of 1.33 (95% CI 1.26 to 1.40), based on fitting a stratified Cox proportional hazards model. The authors conclude that PPI can be used to predict prognosis for patients with advanced cancer.

  • Cancer
  • Hospice care
  • Prognosis

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