Palliative Performance Scale predicts mortality in cardiac intensive care unit
Background The ageing population has led to an increased prevalence of chronic diseases, posing challenges for the management of critically ill cardiac patients with multiple comorbidities. The Palliative Performance Scale (PPS), initially developed for terminally ill cancer patients, has shown prog...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-06-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e003302.full |
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| author | Federica Frascaro Gianni Casella Laura Sofia Cardelli Lorenzo Gamberini Beatrice Dal Passo Silvia Zagnoni Francesca Sciarra Alice Vitagliano Valeria Carinci Maria Laura Canale |
| author_facet | Federica Frascaro Gianni Casella Laura Sofia Cardelli Lorenzo Gamberini Beatrice Dal Passo Silvia Zagnoni Francesca Sciarra Alice Vitagliano Valeria Carinci Maria Laura Canale |
| author_sort | Federica Frascaro |
| collection | DOAJ |
| description | Background The ageing population has led to an increased prevalence of chronic diseases, posing challenges for the management of critically ill cardiac patients with multiple comorbidities. The Palliative Performance Scale (PPS), initially developed for terminally ill cancer patients, has shown prognostic value in various medical settings but remains understudied in cardiac intensive care units (CICUs). This study evaluates the PPS as a prognostic tool for in-hospital and 1-year all-cause mortality in CICU patients.Methods We conducted a single-centre, prospective, observational study at the Maggiore Hospital in Bologna, including 1131 patients admitted to the CICU between August 2022 and November 2023. Patients were stratified into two groups based on their PPS at admission (≤70 and >70). Multivariable regression models were used to assess predictors of mortality, and Kaplan-Meier survival curves were generated. Model accuracy and calibration were evaluated using receiver operating characteristic curves and the Hosmer-Lemeshow test.Results Patients with PPS ≤70 had significantly higher 1-year all-cause mortality (37.0% vs 9.8%, p<0.001) and in-hospital all-cause mortality (17.7% vs 3.3%, p<0.001). In the multivariable regression models, PPS emerged as an independent predictor of both 1-year and in-hospital all-cause mortality, along with age and Sequential Organ Failure Assessment score. The models demonstrated good discriminatory performance (area under the curve of 0.841 for 1-year mortality, 0.862 for in-hospital mortality) and acceptable calibration.Conclusions The PPS is a reliable and independent predictor of mortality in CICU patients. Incorporating PPS into clinical practice may enhance risk stratification, guide decision-making and optimise resource allocation in this high-risk population. |
| format | Article |
| id | doaj-art-4ea0dc387da84b00bdb91f27f9aab5d1 |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-4ea0dc387da84b00bdb91f27f9aab5d12025-08-20T03:26:56ZengBMJ Publishing GroupOpen Heart2053-36242025-06-0112110.1136/openhrt-2025-003302Palliative Performance Scale predicts mortality in cardiac intensive care unitFederica Frascaro0Gianni Casella1Laura Sofia Cardelli2Lorenzo Gamberini3Beatrice Dal Passo4Silvia Zagnoni5Francesca Sciarra6Alice Vitagliano7Valeria Carinci8Maria Laura Canale9Cardiology Department, Università degli Studi di Ferrara, Ferrara, Emilia-Romagna, ItalyCardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, ItalyCardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, ItalyDepartment of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, ItalyCardiology Department, Università degli Studi di Ferrara, Ferrara, Emilia-Romagna, ItalyCardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, ItalyCardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, ItalyCardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, ItalyCardiology Department, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, ItalyCardiology Department, Ospedale Versilia, Lido di Camaiore, Toscana, ItalyBackground The ageing population has led to an increased prevalence of chronic diseases, posing challenges for the management of critically ill cardiac patients with multiple comorbidities. The Palliative Performance Scale (PPS), initially developed for terminally ill cancer patients, has shown prognostic value in various medical settings but remains understudied in cardiac intensive care units (CICUs). This study evaluates the PPS as a prognostic tool for in-hospital and 1-year all-cause mortality in CICU patients.Methods We conducted a single-centre, prospective, observational study at the Maggiore Hospital in Bologna, including 1131 patients admitted to the CICU between August 2022 and November 2023. Patients were stratified into two groups based on their PPS at admission (≤70 and >70). Multivariable regression models were used to assess predictors of mortality, and Kaplan-Meier survival curves were generated. Model accuracy and calibration were evaluated using receiver operating characteristic curves and the Hosmer-Lemeshow test.Results Patients with PPS ≤70 had significantly higher 1-year all-cause mortality (37.0% vs 9.8%, p<0.001) and in-hospital all-cause mortality (17.7% vs 3.3%, p<0.001). In the multivariable regression models, PPS emerged as an independent predictor of both 1-year and in-hospital all-cause mortality, along with age and Sequential Organ Failure Assessment score. The models demonstrated good discriminatory performance (area under the curve of 0.841 for 1-year mortality, 0.862 for in-hospital mortality) and acceptable calibration.Conclusions The PPS is a reliable and independent predictor of mortality in CICU patients. Incorporating PPS into clinical practice may enhance risk stratification, guide decision-making and optimise resource allocation in this high-risk population.https://openheart.bmj.com/content/12/1/e003302.full |
| spellingShingle | Federica Frascaro Gianni Casella Laura Sofia Cardelli Lorenzo Gamberini Beatrice Dal Passo Silvia Zagnoni Francesca Sciarra Alice Vitagliano Valeria Carinci Maria Laura Canale Palliative Performance Scale predicts mortality in cardiac intensive care unit Open Heart |
| title | Palliative Performance Scale predicts mortality in cardiac intensive care unit |
| title_full | Palliative Performance Scale predicts mortality in cardiac intensive care unit |
| title_fullStr | Palliative Performance Scale predicts mortality in cardiac intensive care unit |
| title_full_unstemmed | Palliative Performance Scale predicts mortality in cardiac intensive care unit |
| title_short | Palliative Performance Scale predicts mortality in cardiac intensive care unit |
| title_sort | palliative performance scale predicts mortality in cardiac intensive care unit |
| url | https://openheart.bmj.com/content/12/1/e003302.full |
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