Association between poor oral health and overall mortality in palliative care patients: An analysis using time-dependent receiver operating characteristic curves

Abstract

Aims: To determine the Oral Health Assessment Tool (OHAT) critical score in palliative care patients and the optimal timing for predicting mortality using time-dependent receiver operating characteristic (ROC) curves.

Methods and results: A retrospective observational study was conducted on 176 patients treated by the palliative care team of our medical center between April 2017 and March 2020. Oral health was assessed using the OHAT. Prediction accuracy was evaluated using the area under the curve (AUC) analysis, sensitivity, and specificity, using time-dependent ROC curves. Overall survival (OS) was compared using Kaplan-Meier curves with the log-rank test; hazard ratios (HRs) adjusted for covariates were calculated using a Cox proportional hazard model. A OHAT score of 6 was shown to best predict 21-day OS (AUC 0.681, sensitivity 42.2%, specificity 80.0%). The median OS was significantly shorter in patients with total OHAT scores ≥6 than in patients with scores < 6 (21 days vs. 43 days, p = .017). For individual OHAT items, the unhealthy status of the lips and tongue was associated with decreased OS (HR = 1.91; 95% confidence interval [CI], 1.19-3.05 and adjusted HR = 1.48; 95% CI, 1.00-2.20).

Conclusion: Predicting disease prognosis based on patient oral health can enable clinicians to provide timely treatment.

Keywords: ROC curve; area under the curve; mortality; oral health; palliative care; prognosis; risk factors.