Survival time after marked reduction in oral intake in terminally ill noncancer patients: A retrospective study

Abstract

Background The prediction of short‐term survival is important for noncancer patients and their families. Although a markedly reduced oral intake by cancer patients suggests a poor prognosis, the survival times of noncancer patients after its onset remain unclear. We herein investigated the time from a marked reduction in oral intake to death in noncancer patients as well as factors associated with their subsequent survival. Methods We conducted a retrospective medical record review of noncancer patients who died in our hospital between April 2017 and April 2018. We recorded the day when oral intake markedly decreased and the date of death. We extracted data on age, gender, the Charlson Comorbidities Index, mean daily fluid volume, laboratory test results, and vital signs converted to the Shock Index (SI). We used Cox's proportional hazards models to assess relationships between these factors and survival times after the onset of a markedly reduced oral intake. Results We analyzed data from 44 noncancer patients. The median time from the onset of a markedly reduced oral intake to death was 16.5 days. Based on Cox's proportional hazards models, only SI ≧ 1.0 at the onset of a markedly reduced oral intake correlated with survival times (hazard ratio: 5.89, 95% confidence interval (CI): 1.71‐20.1, P = .005). Conclusion Noncancer patients died a median of 16.5 days after the onset of a markedly reduced oral intake, and SI ≧1.0 correlated with subsequent survival times. These results will provide novel insights into the prognosis of noncancer patients at the end of life.

Prediction Models for Impending Death Using Physical Signs and Vital Signs in Noncancer Patients: A Prospective Longitudinal Observational Study

“…The appearance of a marked reduction in oral intake was adopted as the criterion for the initiation of observations because the median onset of anorexia in terminal cancer and noncancer patients was previously reported to be 7.5 and 16.5 days before death, respectively. 11 , 23 Before the start of this study, a researcher (T.H.) gave a lecture on the 11 physical signs to all nurses working in the internal medicine ward.…”

Variations in vital signs at the end of life in non-cancer patients: a retrospective study

“…The present study involved a secondary analysis of a retrospective study performed to examine survival times following marked decreases in oral intake by non-cancer patients in the dying phase (17). The main retrospective study was a medical chart review of non-cancer patients admitted to the General Medicine Ward of Kamisu Saiseikai Hospital, Ibaraki, Japan.…”

‘How long do you think?’ Unresponsive dying patients in a specialist palliative care service: A consecutive cohort study

“…A decrease in conscious state (where the patient becomes unresponsive), has been accepted as a sign of imminent death, together with resulting swallowing difficulty and reduced oral intake. 9 – 11 Despite much research, such as clinician prediction of survival, 12 – 14 continuous monitoring and observation of signs and symptoms of imminent death 7 , 9 , 15 – 17 and the use of prognostic scales, 6 , 8 , 9 significant uncertainty in accurate prognostication remains in practice.…”