Prognosis prediction with two calculations of Palliative Prognostic Index: further prospective validation in hospice cancer patients with multicentre study.

OBJECTIVES: In palliative care settings, predicting prognosis is important for patients and clinicians. The Palliative Prognostic Index (PPI), a prognostic tool calculated using clinical indices alone has been validated within cancer population. This study was to further test the discriminatory ability of the PPI (ie, its ability to determine whether a subject will live more or less than a certain amount of time) in a larger sample but with a palliative care context and to compare predictions at two different points in time. METHODS: Multicentre, prospective, observational study in 10 inpatient hospices in the UK. The PPI score was calculated on the day of admission (PPI1) and again once on days 3-5 of inpatient stay (PPI2). Patients were followed up for 6 weeks or until death, whichever was earlier. RESULTS: Of the 1164 patients included in the study, 962 had both scores available. The results from PPI2 showed improved sensitivity, specificity, positive predictive value and negative predictive value compared with PPI1. For PPI1versus PPI2, area under receiver operator character curve (ROC) for <21 days were 0.73 versus 0.82 and for ≥42 days prediction 0.72 versus 0.80. The median survival days for patients with PPI1 ≤4, 4.5-6 and >6 were 38 (31 to 44), 17 (14 to 19) and 5 (4 to 7). CONCLUSION: This study showed improved discriminatory ability using the PPI score calculated between day 3and day5 of admission compared with that calculated on admission. This study further validated PPI as a prognostic tool within a palliative care population and showed recording at two time points improved accuracy.

Influence of patient age on the growth and transfer of blastocyst-stage embryos.

OBJECTIVE: To examine the effects of patient age on the growth and transfer of blastocyst-stage embryos. DESIGN: Retrospective clinical study. SETTING: Private assisted reproductive technologies center. PATIENT(S): Three hundred patients between the ages of 18 and 45 undergoing in vitro fertilization. INTERVENTION(S): Bipronucleate oocytes were grown for up to 144 hours and subsequently transferred when at least one embryo attained the expanded blastocyst stage. MAIN OUTCOME MEASURE(S): Oocytes retrieved and fertilized, blastocyst formation rates, implantation rates, and pregnancy rates per retrieval and transfer. RESULT(S): The rate of cycle cancellation before oocyte retrieval increased significantly with age, and the average number of oocytes per retrieval declined significantly with age. Fertilization rates were unrelated to patient age. The proportion of cycles with expanded blastocysts declined significantly with age. Pregnancy rates per stimulation declined with age, but pregnancy rates per transfer were approximately 50% across the entire age range studied. CONCLUSION(S): The decline in female fertility with age appears to be the result of reduced numbers of oocytes and the inability of fertilized oocytes to develop to the blastocyst stage. Implantation and pregnancy rates appear to be unaffected by age when blastocysts do form.