Clinical calculator summary
Palliative Prognostic Index
Clinical calculator summary
Palliative Prognostic Index
Five-factor additive score with two published, overlapping short-term survival thresholds.
Evidence-based context for fast calculator use
- Purpose:
- Support uncertainty-aware short-term prognostic assessment in advanced or terminal cancer.
- Population:
- Advanced or terminal cancer; originally developed and tested in a Japanese hospice inpatient cohort.
- Factors:
- PPS, Oral intake, Edema, Dyspnea at rest, Delirium
- Reference:
- Morita et al. Support Care Cancer. 1999;7(3):128-133. PMID: 10335930.
Palliative Prognostic Index (PPI)
Clinical Context & Background
Add the five source-defined component points; exact total 0-15.Reference Data
| Published threshold | Original prediction target | Original performance |
|---|---|---|
| PPI > 4 | Survival <6 weeks | Sensitivity 80%; specificity 77% |
| PPI > 6 | Survival <3 weeks | Sensitivity 80%; specificity 85% |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- Use in advanced or terminal cancer when all five current bedside assessments are available.
- If assigning PPS with current PPSv2, follow its official definitions, leftward precedence, and best-horizontal-fit instructions.
How To Interpret
- PPI >4 meets the published threshold predicting survival under 6 weeks; PPI >6 meets both that threshold and the threshold predicting survival under 3 weeks.
- Treat the original sensitivity and specificity values as cohort-level performance, not certainty for an individual.
What To Do Next
- Document the components, total, thresholds met, assessment date, and reversible contributors.
- Integrate the result with trajectory, clinical assessment, patient goals, and reassessment after material change.
Limitations
- A score at or below 4 does not prove survival beyond 6 weeks, and the thresholds do not create mutually exclusive deterministic bands.
- The original model predates PPSv2; present-day PPSv2 use requires accurate application of its later official definitions and should be documented as an operational adaptation.
Validated Population
Terminally ill patients with cancer in the original Japanese hospice inpatient cohorts; later prospective validation included hospital, hospice, and home-care settings.
Overlapping thresholds
A PPI of 6.5 meets both published thresholds while remaining a probabilistic cohort-level result.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed PPI cases passed through visible production controls at 0, exact 4.5, and 15 across both overlapping thresholds.
- No unexpected N/A, literal undefined value, stale control, unsupported gauge, or browser-console error was observed.
Case-level evidence is retained in validation/browser-revalidation/palliative-prognostic-index-ppi-2026-08-03.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 20 visible submissions.
- Overall browser status: failed-console. medium: Production emitted minified React error #418 during route loads/reloads used by this run.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/palliative-prognostic-index-ppi.json.
: Full validation test
- Verified all 72 combinations and UI serializations, the 12/14/46 distribution, all 26 totals, scores 0/4/4.5/6/6.5/15, strict cutoffs, metrics, trace, malformed-input rejection, no-default/reset behavior, and immutability.
: Correction history
- Separated normal intake from reduced intake using the mouthfuls boundary, removed favorable defaults and coercive inputs, and replaced invented survival bands with the published overlapping PPI >4 and PPI >6 thresholds.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Frequently Asked Questions
Does PPI <=4 mean survival will exceed 6 weeks?
No. Not meeting the PPI >4 positive threshold does not establish the opposite outcome for an individual.
What happens when PPI is above 6?
Both published thresholds are met: PPI >4 for survival under 6 weeks and PPI >6 for survival under 3 weeks.
Can current PPSv2 be used?
Only with its official definitions and rating method explicit. The original 1999 PPI predates PPSv2, so this is a later operational adaptation.
Evidence-based oncology decision support. Verify with clinical guidelines.