Shock Index and Decreased Level of Consciousness as Terminal Cancer Patients' Survival Time Predictors: A Retrospective Cohort Study Ko Sato, MD, Hideto.

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Shock Index and Decreased Level of Consciousness as Terminal Cancer Patients' Survival Time Predictors: A Retrospective Cohort Study Ko Sato, MD, Hideto Yokoi, MD, PhD, Satoru Tsuneto, MD, PhD Journal of Pain and Symptom Management Volume 51, Issue 2, Pages 220-231.e2 (February 2016) DOI: 10.1016/j.jpainsymman.2015.09.012 Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 1 Flowchart of study design. aPatients with arrhythmias or pacemakers or those taking rate-control medications that could cause pulse deficits were excluded. Journal of Pain and Symptom Management 2016 51, 220-231.e2DOI: (10.1016/j.jpainsymman.2015.09.012) Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 2 Survival times and 95% CIs calculated for given SI values in the Part 1 study (GAM model). Scatter plot by generalized additive models (Part 1 study); part labels a and b show scatter plots for alert patients and patients with DLOC, respectively. We obtained SI values from 440 alert patients and 149 patients with DLOC. The red line shows the mean survival times in days. GAM = generalized additive model; MST = mean survival time; SI = shock index. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.) Journal of Pain and Symptom Management 2016 51, 220-231.e2DOI: (10.1016/j.jpainsymman.2015.09.012) Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 3 Receiver operating characteristic curves of the accuracy of SI for predicting survival times in patients with DLOC. The ability to predict three survival times was compared. AUC = area under the curve; DLOC = decreased level of consciousness; SI = shock index. Journal of Pain and Symptom Management 2016 51, 220-231.e2DOI: (10.1016/j.jpainsymman.2015.09.012) Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 4 Survival times and 95% CIs calculated for given SI values in the Part 2 study (GEE model). Scatter plot by generalized estimating equations with a log link method (Part 2 study); part labels a and b show scatter plots for alert patients and patients with DLOC, respectively. We obtained 4003 SI values from 326 alert patients and 8286 SI values from 568 patients with DLOC. The red line shows the mean survival times in days. GEE = generalized estimating equation; MST = mean survival time; SI = shock index. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.) Journal of Pain and Symptom Management 2016 51, 220-231.e2DOI: (10.1016/j.jpainsymman.2015.09.012) Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions

Supplementary Fig. 1 Forest plot of univariate hazard ratios with 95% confidence intervals for all study patients. Comparison of the risks of death associated with physiological parameters in 589 participants. BT = body temperature; DBP = diastolic blood pressure; DLOC = decreased level of consciousness; HR = hazard ratio; LOC = level of consciousness; MAP = mean arterial pressure; PP = pulse pressure; RR = respiratory rate; SBP = systolic blood pressure; SI = shock index. Journal of Pain and Symptom Management 2016 51, 220-231.e2DOI: (10.1016/j.jpainsymman.2015.09.012) Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions

Supplementary Fig. 2 Survival times and 95% confidence intervals calculated for given SI values in Part 2 study not considered temporal variation of SI (GEE model). Scatter plot by generalized estimating equations with a log link method; part labels a and b show scatter plots for alert patients and patients with DLOC, respectively. The SI values that were lower than that previously used were not incorporated into the analyses to prevent the temporal variation of SI. We obtained 799 SI values from 326 alert patients and 2287 SI values from 568 patients with DLOC. A red line shows the mean survival times in days. GEE = generalized estimating equation; MST = mean survival time; SI = shock index. Journal of Pain and Symptom Management 2016 51, 220-231.e2DOI: (10.1016/j.jpainsymman.2015.09.012) Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions