Background: The Acute Palliative Care Unit (APCU) is an inpatient palliative care program that provides intensive symptom management and facilitates the transition from hospital discharge to hospice. Often patients are admitted to the APCU very late at the end of their disease trajectory. The purpose of this study was to investigate whether systemic inflammatory markers can predict remaining survival in these patients.

Methods: Advanced cancer patients admitted to the APCU at a tertiary cancer center in Korea between April 2015 and March 2016 were included in this retrospective study. Of the 405 consecutive APCU admissions during this time period, there were 312 individual patients. Within this cohort, 267 patients were eligible for this study. Systemic inflammatory markers including albumin level, neutrophil to lymphocyte ratio (NLR), and Advanced Lung cancer Inflammation index (ALI = BMI x Albumin / NLR) were analyzed.

Results: Of the 267 patients analyzed, the median age of patients was 66 (range, 23-97), and 45% were female. Primary cancer types were lung cancer (21%), gastric cancer (17%), colorectal cancer (15%), and pancreatobiliary cancer (14%). Overall survival after admission to the APCU was 21 days. Patients with low albumin level ( < 3.3g/dL) showed shorter survival compared with those with normal albumin level (16 days vs 32 days, hazard ratio [HR] 1.79, 95% CI 1.37-2.33, P < 0.001). Median NLR was 8.7, and patients with high NLR (≥8.7) exhibited poorer survival (HR 1.32, 95% CI 1.03-1.68, P = 0.028). Patients with low ALI ( < 18) had poor prognosis compared with those with high ALI (≥18) (HR 1.54, 95% CI 1.15-2.08, P = 0.004).

Conclusions: Low albumin level ( < 3.3), high NLR (≥8.7), and low ALI ( < 18) may indicate poor prognosis in advanced cancer patients admitted to the APCU. A prospective cohort studies are necessary to validate these results.