The challenge of the multifaceted prognosis in the older people and the Multidimensional Prognostic Index

Mattace-Raso, Francesco

doi:10.1007/s41999-021-00457-9

Cited by 7 publications

(6 citation statements)

References 54 publications

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“…As homeostatic instability due to a frail status involves multiple physiological domains [ 15 ], making patients more vulnerable to stressful situations [ 33 ], a multidimensional approach to assessing older adults is required. MPI, developed to evaluate frailty status in hospitalized patients [ 15 , 33 – 35 ], is one of the most commonly used prognostic tools. Given the accuracy of MPI in stratifying a population according to short- and long-term mortality risk, it has been applied to several cohorts of older people with specific acute and chronic diseases, such as cardiology [ 36 ], oncology [ 37 ], nephrology [ 38 ], gastroenterology [ 39 ], and surgery [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Can the Multidimensional Prognostic Index (MPI) be a predictive instrument for mortality in older adult liver transplant candidates?

Vogliotti,

Ceolin,

Valenti

et al. 2023

Eur Geriatr Med

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Purpose The most recent guidelines recommend that selection of liver transplant recipient patients be guided by a multidimensional approach that includes frailty assessment. Different scales have been developed to identify frail patients and determine their prognosis, but the data on older adult candidates are still inconclusive. The aim of this study was to compare the accuracy of the Liver Frailty Index (LFI) and the Multidimensional Prognostic Index (MPI) as predictors of mortality in a cohort of older people patients being evaluated for liver transplantation. Methods This retrospective study was conducted on 68 patients > 70 years being followed at the University Hospital of Padua in 2018. Clinical information on each patient, Model For End-Stage Liver Disease (MELD), Body Mass Index (BMI), Activities of Daily Living (ADL), Mini Nutritional Assessment (MNA), LFI, MPI, and date-of-death, were recorded. The observational period was 3 years. Results We studied 68 individuals (25 women), with a mean age 72.21 ± 1.64 years. Twenty-five (36.2%) patients died during the observational period. ROC curve analysis showed both MPI and LFI to be good predictors of mortality (AUC 0.7, p = 0.007, and AUC 0.689, p = 0.015, respectively). MELD (HR 1.99, p = 0.001), BMI (HR 2.34, p = 0.001), and poor ADL (HR 3.34, p = 0.04) were risk factors for mortality in these patients, while male sex (HR 0.1, p = 0.01) and high MNA scores (HR 0.57, p = 0.01) were protective factors. Conclusion Our study confirmed the prognostic value of MPI in older adult patients awaiting liver transplantation. In this cohort, good nutritional status and male sex were protective factors, while high MELD and BMI scores and poor functional status were risk factors.

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Section: Discussionmentioning

confidence: 99%

Can the Multidimensional Prognostic Index (MPI) be a predictive instrument for mortality in older adult liver transplant candidates?

Vogliotti,

Ceolin,

Valenti

et al. 2023

Eur Geriatr Med

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“…The Multidimensional Prognostic Index (MPI) is a CGA-based frailty instrument, extensively validated and implemented among more than 56,000 older adults in different settings (e.g., hospital, nursing home, general practice, community) [ 37 ] and with different clinical conditions, including infectious diseases [ 38 , 39 ]. The MPI gives a clinimetric measure of multidimensional frailty [ 38 ] with excellent prognostic value [ 35 , 40 , 41 ]. It also provides useful information in clinical decision making of older patients, for instance in those with acute respiratory failure [ 42 ] and SARS-CoV-2 infection.…”

Section: The Aging Patient—why Is the Elderly Patient Different From ...mentioning

confidence: 99%

Biomarkers for risk stratification and antibiotic stewardship in elderly patients

Falcone¹,

Bauer

Ferrer

et al. 2023

Aging Clin Exp Res

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Purpose Optimal treatment of infections in the elderly patients population is challenging because clinical symptoms and signs may be less specific potentially resulting in both, over- and undertreatment. Elderly patients also have a less pronounced immune response to infection, which may influence kinetics of biomarkers of infection. Methods Within a group of experts, we critically reviewed the current literature regarding biomarkers for risk stratification and antibiotic stewardship in elderly patients with emphasis on procalcitonin (PCT). Results The expert group agreed that there is strong evidence that the elderly patient population is particularly vulnerable for infections and due to ambiguity of clinical signs and parameters in the elderly, there is considerable risk for undertreatment. At the same time, however, this group of patients is particularly vulnerable for off-target effects from antibiotic treatment and limiting the use of antibiotics is therefore important. The use of infection markers including PCT to guide individual treatment decisions has thus particular appeal in geriatric patients. For the elderly, there is evidence that PCT is a valuable biomarker for assessing the risk of septic complications and adverse outcomes, and helpful for guiding individual decisions for or against antibiotic treatment. There is need for additional educational efforts regarding the concept of “biomarker-guided antibiotic stewardship” for health care providers caring for elderly patients. Conclusion Use of biomarkers, most notably PCT, has high potential to improve the antibiotic management of elderly patients with possible infection for improving both, undertreatment and overtreatment. Within this narrative review, we aim to provide evidence-based concepts for the safe and efficient use of PCT in elderly patients.

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“…The Comprehensive Geriatric Assessment (CGA) systematizes the multidimensional and interdisciplinary approach to aging and can evaluate dependence parameters in elderly people with different clinical conditions [3][4][5]. CGA is a set of quantitative tests to analyze the aging process, quality of life, and biofunctional and psychological capacity in elderly health [4,5].…”

Section: Introductionmentioning

confidence: 99%

Melatonin and Cytokines Modulate Daily Instrumental Activities of Elderly People with SARS-CoV-2 Infection

França

Fujimori

Queiroz

et al. 2023

IJMS

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The Comprehensive Geriatric Assessment analyzes the health and quality of life of the elderly. Basic and instrumental daily activities may be compromised due to neuroimmunoendocrine changes, and studies suggest that possible immunological changes occur during infections in the elderly. Thus, this study aimed to analyze cytokine and melatonin levels in serum and correlate the Comprehensive Geriatric Assessment in elderly patients with SARS-CoV-2 infection. The sample consisted of 73 elderly individuals, 43 of whom were without infection and 30 of whom had positive diagnoses of COVID-19. Blood samples were collected to quantify cytokines by flow cytometry and melatonin by ELISA. In addition, structured and validated questionnaires were applied to assess basic (Katz) and instrumental (Lawton and Brody) activities. There was an increase in IL-6, IL-17, and melatonin in the group of elderly individuals with infection. In addition, a positive correlation was observed between melatonin and IL-6 and IL-17 in elderly patients with SARS-CoV-2 infection. Furthermore, there was a reduction in the score of the Lawton and Brody Scale in the infected elderly. These data suggest that the melatonin hormone and inflammatory cytokines are altered in the serum of the elderly with SARS-CoV-2 infection. In addition, there is a degree of dependence, mainly regarding the performance of daily instrumental activities, in the elderly. The considerable impact on the elderly person’s ability to perform everyday tasks necessary for independent living is an extremely important result, and changes in cytokines and melatonin probably are associated with alterations in these daily activities of the elderly.

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The challenge of the multifaceted prognosis in the older people and the Multidimensional Prognostic Index

Cited by 7 publications

References 54 publications

Can the Multidimensional Prognostic Index (MPI) be a predictive instrument for mortality in older adult liver transplant candidates?

Can the Multidimensional Prognostic Index (MPI) be a predictive instrument for mortality in older adult liver transplant candidates?

Biomarkers for risk stratification and antibiotic stewardship in elderly patients

Melatonin and Cytokines Modulate Daily Instrumental Activities of Elderly People with SARS-CoV-2 Infection

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