prognosis
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Prognosis (
Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its population is approximately 10.7 million as of ...
: πρόγνωσις "fore-knowing, foreseeing") is a
medical Medicine is the science Science (from the Latin word ''scientia'', meaning "knowledge") is a systematic enterprise that Scientific method, builds and Taxonomy (general), organizes knowledge in the form of Testability, testable explanations ...

medical
term for predicting the likely or expected development of a disease, including whether the
sign A sign is an object Object may refer to: General meanings * Object (philosophy), a thing, being, or concept ** Entity, something that is tangible and within the grasp of the senses ** Object (abstract), an object which does not exist at ...
s and
symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...
s will improve or worsen (and how quickly) or remain stable over time; expectations of quality of life, such as the ability to carry out daily activities; the potential for complications and associated health issues; and the likelihood of survival (including life expectancy). A prognosis is made on the basis of the normal course of the diagnosed disease, the individual's physical and mental condition, the available treatments, and additional factors. A complete prognosis includes the expected duration, function, and description of the course of the disease, such as progressive decline, intermittent crisis, or sudden, unpredictable crisis. When applied to large
statistical population In statistics, a population is a Set (mathematics), set of similar items or events which is of interest for some question or experiment. A statistical population can be a group of existing objects (e.g. the set of all stars within the Milky Way gal ...
s, prognostic estimates can be very accurate: for example the statement "45% of patients with severe
septic shock Septic shock (namely, '' infection throughout the body'') is a potentially fatal medical condition that occurs when sepsis, which is organ injury or damage in response to infection An infection is the invasion of an organism's body Tissue (b ...
will die within 28 days" can be made with some confidence, because previous research found that this proportion of patients died. This statistical information does not apply to the prognosis for each individual patient, because patient-specific factors can substantially change the expected course of the disease: additional information is needed to determine whether a patient belongs to the 45% who will die, or to the 55% who survive.


Methodology


Disease and prognostic indicators

Prognostic scoring is also used for cancer outcome predictions. A
Manchester scoreManchester score is an indicator of prognosis in small cell lung cancer. It is calculated from a number of physical and biochemical markers. A patient with small cell lung cancer scores one point for each of the following: - * Blood plasma, Serum la ...
is an indicator of prognosis for small-cell
lung cancer Lung cancer, also known as lung carcinoma, is a malignant lung tumor characterized by uncontrolled cell growth in tissue (biology), tissues of the lung. This neoplasm, growth can spread beyond the lung by the process of metastasis into nearby t ...

lung cancer
. For
Non-Hodgkin lymphoma Non-Hodgkin lymphoma (NHL) is a group of blood cancers that includes all types of lymphoma Lymphoma is a group of blood cancer, blood malignancies that develop from lymphocytes (a type of white blood cell). The name often refers to just the c ...
, physicians have developed the
International Prognostic IndexThe International Prognostic Index (IPI) is a clinical tool developed by oncologists to aid in predicting the prognosis of patients with aggressive non-Hodgkin's lymphoma. Previous to IPI's development, the primary consideration in assessing prognos ...
to predict patient outcome. Other medical areas where prognostic indicators are used is in Drug-Induced Liver Injury (DILI) (
Hy's lawHy's law is a rule of thumb that a patient is at high risk of a fatal hepatotoxicity, drug-induced liver injury (DILI) if given a medication that causes hepatocellular injury (not Cholestasis, Hepatobiliary injury) with jaundice. The law is based on ...
) and use of an
exercise stress test Exercise is any bodily activity that enhances or maintains physical fitness Physical fitness is a state of health and well-being Well-being, also known as ''wellness'', ''prudential value'' or ''quality of life'', refers to what is intr ...
as a prognostic indicator after
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when Hemodynamics, blood flow decreases or stops to the coronary artery of the heart, causing damage to the cardiac muscle, heart muscle. The most common symptom is chest pai ...

myocardial infarction
, also use to indicator
multiple myeloma Multiple myeloma (MM), also known as plasma cell myeloma and simply myeloma, is a cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or Metastasis, spread to other parts of the body. These co ...

multiple myeloma
survive rate.


End of life

Studies have found that most doctors are overly optimistic when making a prognosis; they tend to overstate how long a patient might live. For patients who are critically ill, particularly those in an
intensive care unit image:Intensivstation (01) 2007-03-03.jpg, 220px, Intensive care unit An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or he ...
, there are numerical prognostic scoring systems that are more accurate. The most famous of these is the APACHE II scale, which is most accurate when applied in the seven days prior to a patient's predicted death. Knowing the prognosis helps determine whether it makes more sense to attempt certain treatments or to withhold them, and thus plays an important role in end-of-life decisions and advanced care planning.


Estimator

EstimatorIn statistics Statistics is the discipline that concerns the collection, organization, analysis, interpretation, and presentation of data. In applying statistics to a scientific, industrial, or social problem, it is conventional to begin with a ...

Estimator
s that are commonly used to describe prognoses include: *''
Progression-free survivalProgression-free survival (PFS) is "the length of time during and after the treatment of a disease, such as cancer, that a patient lives with the disease but it does not get worse". In oncology Oncology is a branch of medicine that deals with th ...
'' - the length of time during and after medication or treatment during which the disease being treated (usually cancer) does not get worse. *''
Survival rate Survival rate is a part of survival analysis. It is the percentage of people in a study or treatment group still alive for a given period of time after diagnosis. It is a method of describing prognosis in certain disease conditions. Survival rate ...
'' - indicating the percentage of people in a study or treatment group who are alive for a given period of time after diagnosis. *''Survival time'' - the remaining duration of life. If not otherwise specified, it generally starts from the time of diagnosis.


History

One of the earliest written works of medicine is the Book of Prognostics of
Hippocrates Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), ...

Hippocrates
, written around 400 BC. This work opens with the following statement: "It appears to me a most excellent thing for the physician to cultivate Prognosis; for by foreseeing and foretelling, in the presence of the sick, the present, the past, and the future, and explaining the omissions which patients have been guilty of, he will be the more readily believed to be acquainted with the circumstances of the sick; so that men will have confidence to intrust themselves to such a physician." For 19th century physicians, particularly those following the French school of medicine, the main aim of medicine was not to cure disease, but rather to give a
medical diagnosis Medical diagnosis (abbreviated Dx, Dx, or Ds) is the process of determining which disease or condition explains a person's symptoms and medical sign, signs. It is most often referred to as diagnosis with the medicine, medical context being implici ...
and achieve a satisfying ''prognosis'' of the patient's chances. Only several decades later did the focus of efforts in Western medicine shift to curing disease.


See also

*
Medical diagnosis Medical diagnosis (abbreviated Dx, Dx, or Ds) is the process of determining which disease or condition explains a person's symptoms and medical sign, signs. It is most often referred to as diagnosis with the medicine, medical context being implici ...
*
Nocebo A nocebo effect is said to occur when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have. For example, when a patient anticipates a side effect of a medication ...
*
Optimism bias Optimism bias (or the optimistic bias) is a cognitive bias A cognitive bias is a systematic pattern of deviation from norm (philosophy), norm or rationality in judgment. Individuals create their own "subjective reality" from their perception of th ...
*
Placebo (origins of technical term) A placebo ( ) is a substance or treatment which is designed to have no therapeutic value. Common placebos include inert tablets (like sugar pills), inert injections (like Saline (medicine), saline), sham surgery, and other procedures. In general ...
*
Prediction Image:Old Farmer's Almanac 1793 cover.jpg, frame, ''The Old Farmer's Almanac'' is famous in the US for its (not necessarily accurate) long-range weather predictions. A prediction (Latin ''præ-'', "before," and ''dicere'', "to say"), or forecas ...
*
Reference class forecasting Reference class forecasting or comparison class forecasting is a method of predicting the future by looking at similar past situations and their outcomes. The theories behind reference class forecasting were developed by Daniel Kahneman and Amos Tv ...
*
Sign (medicine) Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...
*
Symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...


References


External links


Computer models at prognosis.org
{{Medical terms to describe disease conditions Medical terminology