Blood markers and clinical scores linked to survival in palliative care patients

A single-centre retrospective cohort study of 260 palliative care inpatients has found that a small set of routinely collected clinical and laboratory measures were independently associated with overall survival and 30-day mortality, with the neutrophil-to-lymphocyte ratio showing the strongest observed discrimination for short-term death. The research, published in BMC Palliative Care, included both patients with malignant disease and patients with non-malignant conditions, a combination the authors say is under-represented in existing prognostic studies.

The study, led by Elif Duygu Topan with İmran Kurt Ömürlü and Hilal Bektaş Uysal, examined consecutive eligible adults admitted to a palliative care unit between August 2023 and September 2025. Clinical, laboratory and outcome data were drawn from medical records. Of the 260 patients, 156 (60.0 percent) had malignant disease and 104 (40.0 percent) had non-malignant disease.

Overall survival was analysed using multivariable Cox proportional hazards regression, while 30-day mortality was assessed with multivariable logistic regression. Receiver operating characteristic analysis evaluated how well CCI, PNI and NLR discriminated between patients who died within 30 days and those who survived longer. Analyses were run for the full cohort and separately for the malignant and non-malignant subgroups.

In the overall cohort, all four measures — ECOG PS, CCI, PNI and NLR — were independently associated with overall survival. For 30-day mortality, ECOG PS, CCI and NLR were independently associated, while PNI was not. The subgroup results were more nuanced: PNI was associated with overall survival in non-malignant but not malignant patients, and with 30-day mortality only in the non-malignant subgroup, whereas NLR remained associated with both outcomes in both subgroups.

The discrimination analysis highlighted NLR. It had the highest observed area under the curve for 30-day mortality in the overall cohort, at 0.745 (95 percent confidence interval, 0.687–0.796), and an area under the curve of 0.776 (95 percent confidence interval, 0.683–0.852) in the non-malignant subgroup. These values indicate moderate discriminative performance, and the confidence intervals reflect the uncertainty inherent in a cohort of this size.

The authors conclude that functional status, comorbidity burden and routinely available laboratory indices were associated with prognosis in palliative care patients. They note that NLR showed the highest observed discrimination for 30-day mortality and remained associated with both outcomes across malignant and non-malignant subgroups, while PNI’s associations were confined to overall survival in the overall cohort and the non-malignant subgroup, and to 30-day mortality in the non-malignant subgroup only.

Accurate prognostic assessment matters in palliative care because it supports treatment planning, goal setting and communication with patients and families, the study’s background section notes. The authors point out that although functional status, comorbidity burden and laboratory indices have each been linked to prognosis individually, evidence on their simultaneous contribution in real-world mixed palliative populations has been limited. As a retrospective single-centre study of 260 consecutive eligible adults, the findings describe associations observed in one setting; the article is an early-release, peer-reviewed accepted version subject to further edits.

Subject of Research: Prognostic associations of clinical and laboratory markers with survival in palliative care patients

Article Title: Prognostic associations of clinical indices and laboratory-based markers with overall survival and 30-day mortality in malignant and non-malignant palliative care patients: a retrospective cohort study

Article References: Topan, E. D., Kurt Ömürlü, İ., & Bektaş Uysal, H. (2026). Prognostic associations of clinical indices and laboratory-based markers with overall survival and 30-day mortality in malignant and non-malignant palliative care patients: a retrospective cohort study. BMC Palliative Care. https://doi.org/10.1186/s12904-026-02403-7

Image Credits: AI Generated

DOI: 10.1186/s12904-026-02403-7

Keywords: palliative care, overall survival, 30-day mortality, neutrophil-to-lymphocyte ratio, Prognostic Nutritional Index, Charlson Comorbidity Index, ECOG performance status, retrospective cohort study, prognosis, BMC Palliative Care, Prognostic, associations