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NECPAL prognostic tool: a palliative medicine retrospective cohort study
  1. Pamela Turrillas1,2,
  2. Judith Peñafiel3,4,
  3. Cristian Tebé3,4,
  4. Jordi Amblàs-Novellas1,2,5 and
  5. Xavier Gómez-Batiste1,2,5
  1. 1The 'Qualy' Observatory, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
  2. 2Chair of Palliative Care, University of Vic, Vic, Barcelona, Spain
  3. 3Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
  4. 4Biostatistics Unit, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain
  5. 5Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic – University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Barcelona, Spain
  1. Correspondence to Dr Jordi Amblàs-Novellas, Chair of Palliative Care, University of Vic, Vic, Barcelona, Spain; jordi.amblas{at}


Objective To develop and validate a prognostic model to assess mortality risk at 24 months in patients with advanced chronic conditions.

Methods Retrospective design based on a previous population cohort study with 789 adults who were identified with the surprise question and NECPAL tool from primary and intermediate care centres, nursing homes and one acute hospital of Spain. A Cox regression model was used to derive a mortality predictive model based on patients’ age and six previously selected NECPAL prognostic factors (palliative care need identified by healthcare professionals, functional decline, nutritional decline, multimorbidity, use of resources, disease-specific criteria of severity/progression). Patients were split into derivation/validation cohorts, and four steps were followed: descriptive analysis, predictors’ assessment, model estimation and model assessment.

Results All predictive variables were independently associated with increased risk of mortality at 24 months. Performance model including age was good; discrimination power by area under the curve (AUC) was 0.72/0.67 in the derivation/validation cohorts, and correlation between expected and observed (E/O) mortality ratio was 0.74/0.70. The model showed similar performance across settings (AUC 0.65–0.74, E/O 1.00–1.01), the best performance in oncological patients (AUC 0.78, E/O 0.76) and the worst in dementia patients (AUC 0.58, E/O 0.85). Based on the number of factors affected, three prognostic stages with significant differences and a median survival of 38, 17.2 and 3.6 months (p<0.001) were defined.

Conclusion The NECPAL prognostic tool is accurate and eventually useful at the clinical practice. Stratification in risk groups may enable early intervention and enhance policy-making and service planning.

  • prognosis

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  • Contributors PT, JP, CT, JA-N and XG-B conceptualised and designed the study. JP and CT performed the statistical analysis; PT, JP, CT, XG-B and JA-N contributed to data analysis and interpretation of the findings. PT, JP, CT and XG-B drafted the manuscript and reviewed and approved the final manuscript. All authors meet the conditions of the International Committee of Medical Journal Editors regarding authorship.

  • Funding This research was funded by the Balmes University Foundation and did not receive any other specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Research Ethics Committee of the University of Vic ‒ Central University of Catalonia.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information.