Abstract
Background
Ascites is common in patients with advanced cancer and is associated with systemic inflammation, malnutrition, and organ dysfunction. Although the Palliative Prognostic Index (PPI) is widely used to predict short-term survival in terminally ill cancer patients, ascites is not included in its components. We investigated whether ascites influences survival and modifies the prognostic performance of the PPI in terminally ill cancer patients.Methods
This was a secondary analysis of the multicenter prospective the East-Asian cross-cultural collaborative Study to Elucidate the Dying process (EASED) study conducted in 23 palliative care units in Japan. Patients were classified according to the presence of edema and ascites at admission into four groups: G1 (edema+/ascites+), G2 (edema+/ascites-), G3 (edema-/ascites+), and G4 (edema-/ascites-). The primary outcome was the distribution of PPI scores according to edema and ascites status. Secondary outcomes included overall survival (OS) and the predictive performance of PPI thresholds for survival prediction.Results
Among 1889 patients, the distribution of PPI scores differed across the four groups. Median OS was shortest in G1 (13 days), followed by G2 (15 days), G3 (17 days), and longest in G4 (28 days) (P Conclusions
Ascites is associated with shorter survival and modifies the clinical interpretation of the PPI. In patients with ascites, reliance on PPI alone may underestimate short-term mortality. Incorporating ascites assessment into prognostic evaluation may improve clinical decision-making in end-of-life care.