Serum Creatinine as a Clinical Parameter for Patients with Cancer in End-of-Life: a retrospective cohort study in an acute palliative care unit

Abstract

Background: Prognosis prediction is a challenge for clinicians caring for patients with cancer in end-of-life. Although previous studies have shown several biological parameters to be prognostic factors, it remains unclear which factors can predict the exact prognosis. Additionally, blood tests for patients with terminal cancer are limited, it is practically difficult to utilize usual parameters as prognostic factors. Therefore, a universal, readily available, and the cost-effective clinical parameter is needed to predict the survival times of patients with cancer in end-of-life regardless of age, sex, or cancer type.Methods: We analyzed the medical records of 280 patients admitted to the palliative care unit at Korea University Guro Hospital from July 2019 to June 2021. After analysis of survival time according to patients’ clinical parameters, Kaplan-Meier survival curves using Serum Creatinine (Scr) levels (cut-off: 1.2 mg/dL) were plotted and compared using the log-rank test. Finally, using stepwise selection, multivariable Cox proportional hazard model was used to identify significant prognostic factors.Results: Patients with high Scr (≥1.2 mg/dL) had shorter median survival than those with normal levels (12 days vs 23 days). Multivariate Cox proportional hazard model identified male (HR=1.47; P=0.019), stomach cancer (HR=1.88; P=0.020), poor performance status (HR=1.56; P=0.004), leukocytosis (HR=1.81; P<0.001), high AST (HR=1.57; P=0.004), and high Scr (HR=1.54; P=0.022) as significantly associated with shorter survival time.Conclusions: High Scr was significantly associated with poor survival in patients with cancer near end-of-life. This readily available and simple clinical parameter might be helpful in predicting prognosis in palliative care settings.