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. 2025 Aug;20(8):829-836.
doi: 10.1002/jhm.70012. Epub 2025 Feb 17.

Performance of electronic medical record tool in predicting 6-month mortality in hospitalized patients with cancer

Nita S Kulkarni  1 , Matthew P Landler  1 , Elaine R Cohen  1 , Diane B Wayne  2 , Eytan Szmuilowicz  1
Affiliations

Performance of electronic medical record tool in predicting 6-month mortality in hospitalized patients with cancer

Nita S Kulkarni et al. J Hosp Med. 2025 Aug.

Abstract

Background: A systematic tool to identify hospitalized patients with high mortality risk may be beneficial for targeting palliative care to those in greatest need.

Objective: Evaluate the performance of the End-of-life Index (EOLI; Epic Systems Corporation) in identifying patients at the highest 6-month mortality risk among hospitalized patients with cancer.

Methods: We conducted a retrospective study of adults with cancer admitted to oncology services in a 959-bed hospital between July 1 and December 31, 2023. We evaluated EOLI score performance in determining mortality risk using the area under the receiver operating characteristic curve (AUC). The primary outcome was 6-month mortality for patients with an EOLI score above and below the optimal threshold value. Secondary outcomes included in-hospital mortality, 30-day mortality, length of stay, intensive care unit (ICU) utilization, palliative care consultation, do-not-resuscitate status on discharge, and discharge disposition.

Results: The EOLI score had moderate accuracy in identifying patients at higher risk of 6-month mortality (AUC: 0.71) with an optimal threshold value of 40. For patients with EOLI > 40 and < 40, the 6-month mortality was 45.9% and 16.3%, respectively (p < .001). Patients with EOLI > 40 had higher ICU utilization (12.4% vs. 6.5%, p = .002) and were more likely to be discharged to a location other than home (13.5% vs. 5.3%; p < .001).

Conclusions: For hospitalized patients with cancer, the EOLI shows moderate accuracy in identifying patients with a high risk of 6-month mortality. As a screening tool, the EOLI can be used to identify patients who may benefit from timely palliative care.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Receiver operating characteristic (ROC) curve for the diagnostic ability of the End‐of‐Life Index (EOLI) score to predict 6‐month mortality in hospitalized patients with cancer with an area under the receiver operating characteristic curve (AUC) of 0.71 and an optimal cutoff value of 40.
Figure 2
Figure 2
Six‐month mortality rates by the End‐of‐Life Index (EOLI) score decile range.
See this image and copyright information in PMC

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