Comparing the Prognostic Accuracy for All-Cause Mortality of Frailty Instruments: A Multicentre 1-Year Follow-Up in Hospitalized Older Patients

Pilotto, Alberto; Rengo, Franco; Marchionni, Niccolò; Sancarlo, Daniele; Fontana, Andrea; Panza, Francesco; Ferrucci, Luigi

doi:10.1371/journal.pone.0029090

Cited by 177 publications

(153 citation statements)

References 40 publications

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“…Frailty has been associated with morbidity and mortality in multiple settings. Frailty has been associated with short-and long-term all-cause mortality in hospitalized patients older than 64 years [17] and is an accessible tool for estimating individual risks of mortality [16]. In the surgical setting, frailty increases postoperative complications, institutional discharge, inhospital mortality, and length of stay [14,17,23].…”

Section: Introductionmentioning

confidence: 99%

Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

Patel

Brennan

et al. 2014

Clinical Orthopaedics &Amp; Related Research

134

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Background Frailty, a multidimensional syndrome entailing loss of energy, physical ability, cognition, and health, plays a significant role in elderly morbidity and mortality. No study has examined frailty in relation to mortality after femoral neck fractures in elderly patients. Questions/purposes We examined the association of a modified frailty index abbreviated from the Canadian Study of Health and Aging Frailty Index to 1-and 2-year mortality rates after a femoral neck fracture. Specifically we examined: (1) Is there an association of a modified frailty index with 1-and 2-year mortality rates in patients aged 60 years and older who sustain a low-energy femoral neck fracture? (2) Do the receiver operating characteristic (ROC) curves indicate that the modified frailty index can be a potential tool predictive of mortality and does a specific modified frailty index value demonstrate increased odds ratio for mortality? (3) Do any of the individual clinical deficits comprising the modified frailty index independently associate with mortality? Methods We retrospectively reviewed 697 low-energy femoral neck fractures in patients aged 60 years and older at our Level I trauma center from 2005 to 2009. A total of 218 (31%) patients with high-energy or pathologic fracture, postoperative complication including infection or revision surgery, fracture of the contralateral hip, or missing documented mobility status were excluded. The remaining 481 patients, with a mean age of 81.2 years, were included. Mortality data were obtained from a state vital statistics department using date of birth and Social Security numbers. Statistical analysis included unequal variance t-test, Pearson correlation of age and frailty, ROC curves and area under the curve, Hosmer-Lemeshow statistics, and logistic regression models. Results One-year mortality analysis found the mean modified frailty index was higher in patients who died (4.6 ± 1.8) than in those who lived (3.0 ± 2; p \ 0.001), which was maintained in a 2-year mortality analysis (4.4 ± 1.8 versus 3.0 ± 2; p\0.001). In ROC analysis, the area under the curve was 0.74 and 0.72 for 1-and 2-year mortality, respectively. Patients with a modified frailty index of 4 or greater had an odds ratio of 4.97 for 1-year mortality and an odds ratio of 4.01 for 2-year mortality as compared with patients with less than 4. Logistic regression models demonstrated that the clinical deficits of mobility, respiratory, renal, malignancy, thyroid, and impaired cognition were independently associated with 1-and 2-year mortality. Conclusions Patients aged 60 years and older sustaining a femoral neck fracture, with a higher modified frailty index, had increased 1-and 2-year mortality rates, and the ROC Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of...

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Section: Introductionmentioning

confidence: 99%

Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

Patel

Brennan

et al. 2014

Clinical Orthopaedics &Amp; Related Research

134

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“…8,9 The Multidimensional Prognostic Index (MPI) is a validated index based on six commonly used geriatric assessment scales exploring cognitive, functional, nutritional, and clinical status, as well as on information about drugs taken and patient's social support. 10 Its long-term predictive value has been established in the overall hospitalized population 11 as well as in older subjects hospitalized for specific clinical conditions. [12][13][14][15][16] Recently, we have demonstrated the validity of MPI in predicting in-hospital mortality and length of hospital stay (LOS) among patients with multiple types of diseases and causes of hospitalization, 17 but no data are available on change in MPI score over hospital stay and on its sensitivity to patient's clinical modification over time.…”

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confidence: 99%

Change in the Multidimensional Prognostic Index Score During Hospitalization in Older Patients

Volpato

Daragjati

Simonato

et al. 2016

Rejuvenation Research

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on behalf of the MPI-TriVeneto Study Group * AbstractWe investigated and describe change in the Multidimensional Prognostic Index (MPI) score between admission and discharge in 960 older patients admitted to 20 geriatric units for an acute disease or a relapse of a chronic disease. The MPI was calculated at admission and at discharge. Subjects were divided into three groups of MPI score, low risk (MPI-1 value £0.33), moderate risk (MPI-2 value 0.34-0.66), and severe risk of mortality (MPI-3 value ‡0.67), on the basis of previously established cutoffs. Variation of MPI values over length of hospital stay (LOS) was analyzed with a multivariable longitudinal linear model for repeated measurements. At admission, 23.5% subjects had an MPI-1 score, 33.3% had an MPI-2 score, and 43.0% had an MPI-3 score. Overall, for almost 60% of the patients, MPI score at hospital discharge was different compared with the score at admission, although the difference was not statistically significant (-0.003; p = 0.708). Patients with high and intermediate MPI scores at admission had a decrease of MPI score at discharge (delta-MPI -0.026, p < 0.001, and delta-MPI -0.066, p = 0.569, respectively), whereas patients in the MPI-low group, experienced a significant increase in MPI score (delta-MPI 0.041, p < 0.001). The evolution of MPI score as a function of LOS had a curvilinear shape because it significantly decreased for patients with short hospitalization (1-6 days) and tended to increase for those with longer LOS. The MPI, a well-established prognostic tool, is sensitive to change of patient's health status and might be used to objectively track and monitor the clinical evolution of acutely ill geriatric patients admitted to the hospital.

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“…9 Furthermore, initial evidence suggests that the MPI can be considered as universal patient-centred end-point to assess the effects of pharmacological and non-pharmacological interventions in patients with dementia and depression. 10,11 This approach allows the quantification of the effects of therapy on the MPI score as a whole as well as on the scores of individual components of the tool.…”

Section: Multidimensional Prognostic Index In Frail Older Patientsmentioning

confidence: 99%

Using the multidimensional prognostic index for treatment decisions and monitoring in frail older patients

Mangoni

2017

Geriatr Care

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The routine applicability of clinical guidelines and disease-specific end-points in frail older patients is problematic because of the exclusion of this group from clinical trials, their limited life expectancy, the co-existence of multiple disease states and poor functional status, and the presence of complex drug-drug and drug-disease interactions. In this context, the use of patient-centred end-points that include measures of quality of life might be particularly useful for designing tailored treatment strategies, monitor progress and, ultimately, improve outcomes. The multidimensional prognostic index, an objective, quantifiable, and validated scoring system based on core domains of the comprehensive geriatric assessment, might represent an important tool for the development of clinical guidelines that take into account measures of frailty and patientcentred end-points. However, research is warranted to investigate whether this approach leads to more effective and safe management strategies in old age.

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Comparing the Prognostic Accuracy for All-Cause Mortality of Frailty Instruments: A Multicentre 1-Year Follow-Up in Hospitalized Older Patients

Cited by 177 publications

References 40 publications

Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

Change in the Multidimensional Prognostic Index Score During Hospitalization in Older Patients

Using the multidimensional prognostic index for treatment decisions and monitoring in frail older patients

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