Development and Internal Validation of the Palliative Metabolic Risk Score (PMRS) for Predicting Critical Outcome in...

Area of Science:

• Palliative Care Medicine
• Internal Medicine
• Clinical Chemistry

Background:

• In-hospital critical outcomes are high in palliative patients, often due to acute instability.
• Diabetes Mellitus (DM) is common but its independent impact on critical outcomes is unclear.
• This study investigates acute metabolic and inflammatory markers as predictors of critical outcomes.

Purpose of the Study:

• To determine if acute metabolic and inflammatory markers predict short-term outcomes better than DM status alone in palliative inpatients.
• To identify key physiological markers for predicting in-hospital critical outcomes or ICU transfer.
• To assess the prognostic value of glucose, CRP, albumin, and oxygen requirement.

Main Methods:

• Retrospective study of 200 palliative inpatients (Jan 2024-Jan 2025).
• Data collected: demographics, clinical information, laboratory results (glucose, CRP, albumin).
• Logistic regression and ROC analyses used to identify predictors and optimal thresholds.

Main Results:

• DM (30.5%) did not independently predict critical outcomes (p=0.904).
• Significant predictors: oxygen requirement (OR=4.08), glucose (OR=1.01), and cancer (OR=3.28).
• Optimal thresholds: CRP > 64.1 mg/L, albumin < 25 g/L; risk stratification showed increasing critical outcome rates (39.0% to 85.4%).

Conclusions:

• Acute metabolic and inflammatory markers (hyperglycemia, elevated CRP, hypoalbuminemia, oxygen need) are stronger predictors than DM.
• These markers can improve prognostic accuracy in palliative care.
• A simple bedside model using these parameters may enhance patient communication and care planning.