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Review
. 2012 May;125(5):512.e1-6.
doi: 10.1016/j.amjmed.2011.07.028. Epub 2011 Oct 24.

Systematic Review of Noncancer Presentations With a Median Survival of 6 Months or Less

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Review

Systematic Review of Noncancer Presentations With a Median Survival of 6 Months or Less

Shelley R Salpeter et al. Am J Med. .

Abstract

Purpose: We report on clinical indicators of 6-month mortality in advanced noncancer illnesses and the effect of treatment on survival.

Methods: The MEDLINE database was searched comprehensively to find studies evaluating survival for common advanced noncancer illnesses. We retrieved and evaluated studies that reported a median survival of ≤1 year and evaluated prognostic factors or effect of treatment on survival. We extracted data on presentations with median survivals of ≤6 months for heart failure, chronic obstructive pulmonary disease, dementia, geriatric failure to thrive, cirrhosis, and end-stage renal failure. Independent risk factors for survival were combined and included if their combination was associated with a 6-month mortality of ≥50%.

Results: The search identified 1000 potentially relevant studies, of which 475 were retrieved and evaluated, and 74 were included. We report the common clinical presentations that are consistently associated with a 6-month median survival. Even though advanced noncancer syndromes differ clinically, a universal set of prognostic factors signals progression to terminal disease, including poor performance status, advanced age, malnutrition, comorbid illness, organ dysfunction, and hospitalization for acute decompensation. Generally, a 6-month median survival is associated with the presence of 2-4 of these factors. With few exceptions, these terminal presentations are quite refractory to treatment.

Conclusion: This systematic review summarizes prognostic factors common to advanced noncancer illness. There is little evidence at present that treatment prolongs survival at these terminal stages.

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