Multidimensional Prognostic Index in Association with Future Mortality and Number of Hospital Days in a Population-Based Sample of Older Adults: Results of the EU Funded MPI_AGE Project

Abstract

BackgroundThe Multidimensional Prognostic Index (MPI) has been found to predict mortality in patients with a variety of clinical conditions. We aimed to assess the association of the MPI with future mortality and number of in-hospital days for the first time in a population-based cohort.MethodsThe study population consisted of 2472 persons, aged 66–99 years, from the Swedish National Study on Aging and Care in Kungsholmen, Sweden, who underwent the baseline visit 2001–4, and were followed up >10 years for in-hospital days and >12 years for mortality. The MPI was a modified version of the original and aggregated seven domains (personal and instrumental activities of daily living, cognitive function, illness severity and comorbidity, number of medications, co-habitation status, and nutritional status). The MPI score was divided into risk groups: low, medium and high. Number of in-hospital days (within 1, 3 and 10 years) and mortality data were derived from official registries. All analyses were age-stratified (sexagenarians, septuagenarians, octogenarians, nonagenarians).ResultsDuring the follow-up 1331 persons (53.8%) died. Laplace regression models, suggested that median survival in medium risk groups varied by age from 2.2–3.6 years earlier than for those in the corresponding low risk groups (p = 0.002-p<0.001), and median survival in high risk groups varied by age from 3.8–9.0 years earlier than for corresponding low risk groups (p<0.001). For nonagenarians, the median age at death was 3.8 years earlier in the high risk group than for the low risk group (p<0.001). The mean number of in-hospital days increased significantly with higher MPI risk score within 1 and 3 years for people of each age group.ConclusionFor the first time, the effectiveness of MPI has been verified in a population-based cohort. Higher MPI risk scores associated with more days in hospital and with fewer years of survival, across a broad and stratified age range.

Neuropsychological Correlates of Pre-Frailty in Neurocognitive Disorders: A Possible Role for Metacognitive Dysfunction and Mood Changes

“…The MPI includes information on clinical, functional, nutritional, and neuropsychological aspects, as well as polypathology, pharmacological treatment, and the social support network ( 22 , 25 , 26 , 35 – 40 ). Specifically, the MPI is calculated using a mathematical algorithm that includes scores of individual profiles obtained from the eight evaluation tools that make up the CGA: 1. activity of daily living scale (ADL); 2. instrumental activity of daily living scale (iADL); 3. short portable mental status questionnaire (to assess cognitive status); 4. cumulative illness rating scale—comorbidity index (CIRS-CI, to explore comorbidity); 5.…”

Orthogeriatric care: improving patient outcomes

“…A study has found high Multidimensional Prognostic Index scores to be associated with longer hospital stays and poorer survival rates. 109 A retrospective study analyzed the main comorbidities found in patients admitted due to hip fracture and their influence on mortality. A 12-month post-discharge mortality predictive model, based on comorbidities, included patient age, cognitive impairment, and surgical delay, and was able to explain 26% of the variability in mortality.…”

The Multidimensional Prognostic Index in general practice: One‐year follow‐up study

“…The MPI is largely validated and is known as a reliable, feasible prognosis calculation tool in hospitalised patients, also considering that the present study is one of the very few MPI investigations on outpatients. (Reviewer 2: #5) Although inpatient (Reviewer 1: #1) assessment instruments are not automatically useful in general practice and the MPI‐assessment represents just a snapshot in time, it is remarkable that its performance in this study is equally predictive for adverse outcomes as the judgement of a long‐term treating GP physician.…”