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Prognosis prediction with two calculations of Palliative Prognostic Index: further prospective validation in hospice cancer patients with multicentre study
  1. Sivakumar Subramaniam1,
  2. Pauline Dand2,3,
  3. Martin Ridout4,
  4. Declan Cawley5,
  5. Sophie Miller6,
  6. Paola Valli7,
  7. Rebecca Bright8,
  8. Brendan O’Neill9,
  9. Tricia Wilcocks1,
  10. Georgina Parker10 and
  11. Dee Harris11
  1. 1 Department of Palliative Medicine, Ellenor Hospice, Gravesend, UK
  2. 2 Department of Palliative Medicine, Pilgrims Hospices, Canterbury, UK
  3. 3 CHSS, University of Kent, Canterbury, Kent, United Kingdom
  4. 4 Department of Statistics, University of Kent, Canterbury, UK
  5. 5 Department of Palliative Medicine, Pilgrims Hospices, Ashford, UK
  6. 6 Department of Palliative Medicine, Saint Joseph’s Hospice, London, UK
  7. 7 Department of Palliative Medicine, Heart of Kent Hospice, Aylesford, UK
  8. 8 Department of Palliative Medicine, Pilgrims Hospice, Thanet, UK
  9. 9 Department of Palliative Medicine, Greenwich and Bexley Community Hospice, London, UK
  10. 10 Department of Palliative Medicine, Hospice in the Weald, Tunbridge Wells, UK
  11. 11 Department of Palliative Medicine, Marie Curie Hospice, Solihull, UK
  1. Correspondence to Dr Sivakumar Subramaniam; drsivakumar{at}, drsivaks{at}


Objectives In palliative care settings, predicting prognosis is important for patients and clinicians. The Palliative Prognostic Index (PPI), a prognostic tool calculated using clinical indices alone has been validated within cancer population. This study was to further test the discriminatory ability of the PPI (ie, its ability to determine whether a subject will live more or less than a certain amount of time) in a larger sample but with a palliative care context and to compare predictions at two different points in time.

Methods Multicentre, prospective, observational study in 10 inpatient hospices in the UK. The PPI score was calculated on the day of admission (PPI1) and again once on days 3–5 of inpatient stay (PPI2). Patients were followed up for 6 weeks or until death, whichever was earlier.

Results Of the 1164 patients included in the study, 962 had both scores available. The results from PPI2 showed improved sensitivity, specificity, positive predictive value and negative predictive value compared with PPI1. For PPI1versus PPI2, area under receiver operator character curve (ROC) for <21 days were 0.73 versus 0.82 and for ≥42 days prediction 0.72 versus 0.80. The median survival days for patients with PPI1 ≤4, 4.5–6 and >6 were 38 (31 to 44), 17 (14 to 19) and 5 (4 to 7).

Conclusion This study showed improved discriminatory ability using the PPI score calculated between day 3and day5 of admission compared with that calculated on admission. This study further validated PPI as a prognostic tool within a palliative care population and showed recording at two time points improved accuracy.

  • palliative
  • prognosis
  • prognostic tool
  • cancer
  • hospice
  • palliative prognostic index

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  • Contributors SS conceived the study. SS, PD and MR designed the study. PD and SS managed the study. SS, PD, DC, SM, PV, RB, BO, TW, GP and DH managed each research site and collected data. MR provided full statistical support and analysed the data. SS wrote the original draft. PD and DC critically reviewed the paper. All authors approved the final draft.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethics approval was obtained from the Yorkshire and Humberside Research Ethics Committee (Ref:12/YH/0129).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators University of Kent