Nutritional Predictors of Survival in Terminally Ill Cancer Patients

預測癌症末期病患存活之營養指標

何聖佑(Sheng-Yow Ho) ； 郭浩然(How-Ran Guo) ； 陳海雯(Helen H. W. Chen) ； 彭巧珍(Cheau-Jane Peng)

《Journal of the Formosan Medical Association》 102卷8期 (2003/08) Pp. 544-550

https://doi.org/10.29828/JFMA.200308.0005

並列摘要

Background and Purpose: Malnutrition can affect the prognosis of terminally ill patients, but over-treatment of malnutrition can worsen patients’ quality of life. Decisions on nutrition and the supply of fluids to terminally ill patients are complex, and the identification of useful clinical indicators is needed. This study evaluated the relationships between various nutritional indices and survival of terminally ill cancer patients.
Methods: We recruited terminally ill patients from a teaching hospital between February 2000 and January 2001. All of the 145 candidates were cancer patients, 109 (75%) of whom agreed to participate. Nutritional assessments including physical examination, anthropometric measurements, and biochemical profiles were performed on admission.
Results: Univariate analyses showed that triceps skin-fold thickness (TSF) and midarm muscle circumference were significant predictors of survival. Poor survival was associated with prealbumin ≤100 mg/L (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.1 to 2.3; p=0.03), asparate transaminase (AST) ＞ 45 U/L (HR, 1.6; 95% CI, 1.1 to 2.3; p = 0.03), alkaline phosphatase ＞ 120 U/L (HR, 1.6; 95% CI, 1.1 to 2.5; p = 0.02), creatinine ＞ 1.4 mg/dL (HR,1.9; 95% CI, 1.2 to 3.2; p = 0.01), and blood urea nitrogen (BUN) ＞ 20 mg/dL (HR, 1.9; 95% CI, 1.3 to 2.8; p ＜ 0.01) at admission. Multivariate analyses found that TSF ＜ 25% of the nomogram (HR, 2.9; 95% CI, 1.6 to 5.3; p ＜ 0.01), prealbumin ≤ 100 mg/L (HR, 2.2; 95% CI, 1.4 to 3.5; p ＜ 0.01), AST ＞ 45 U/L (HR, 2.0; 95% CI, 1.3 to 3.2; p = 0.01), and BUN ＞ 20 mg/dL (HR, 2.8; 95% CI, 1.7 to 4.5; p ＜ 0.01) were independent predictors of poor survival.
Conclusions: This study found that nutritional status was associated with the survival of terminally ill cancer patients. Both TSF and prealbumin appeared to be useful predictors that may help set strategies to improve palliative care. Because predictors of survival are not necessarily factors that actually influence survival, further studies should be conducted to evaluate the usefulness of these prognostic indicators in clinical practice.

並列關鍵字

Anthropometry ； Biochemistry ； Nutritional status ； Prealbumin ； Terminal care