The Multidimensional Prognostic Index (MPI), Based on a Comprehensive Geriatric Assessment Predicts Short- and Long-Term Mortality in Hospitalized Older Patients with Dementia

Sancarlo, Daniele; Paris, Francesco; Cascavilla, Leandro; Addante, Filomena; Seripa, Davide; Solfrizzi, Vincenzo; Dallapiccola, Bruno; Franceschi, Marilisa; Ferrucci, Luigi

doi:10.3233/jad-2009-1139

Cited by 76 publications

(69 citation statements)

References 39 publications

(36 reference statements)

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“…In a previous report, we demonstrated that the Multidimensional Prognostic Index, derived from a standardized comprehensive geriatric assessment, was effective in predicting short-and long-term mortality risk in elderly subjects with dementia admitted to a geriatric hospital ward (Pilotto et al 2009). Overall taken together, these findings supported the concept that considering multidimensional aggregate information and frailty syndrome could be very important for predicting short-and long-term all-cause mortality in older subjects with dementia and that it may be important for the identification of the more adequate management of patients.…”

Section: Discussionmentioning

confidence: 97%

Frailty syndrome and all-cause mortality in demented patients: the Italian Longitudinal Study on Aging

Solfrizzi

Scafato

Frisardi

et al. 2011

AGE

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Cognition has already been considered as a component of frailty, and it has been demonstrated that it is associated with adverse health outcomes. We estimated the prevalence of frailty syndrome in an Italian older population and its predictive role on allcause mortality and disability in nondemented subjects and in demented patients. We evaluated 2,581 individuals recruited from the Italian Longitudinal Study on Aging, a population-based sample of 5,632 subjects, aged 65-84 years old. Participants received identical baseline evaluation at the 1st survey (1992)(1993) and were followed at 2nd (1995)(1996) and 3rd survey (2000)(2001). A phenotype of frailty according to partially modified measurement of Cardiovascular Health Study criteria was operationalized. The overall prevalence of frailty syndrome in this populationbased study was 7.6% (95% confidence interval (CI) 6.55-8.57). Frail individuals noncomorbid or nondisable were 9.1% and 39.3%, respectively, confirming an overlap but not concordance in the cooccurrence among these conditions. Frailty was associated with a significantly increased risk of allcause mortality over a 3-year follow-up (hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.52-2.60) and over a 7-year follow-up (HR 1.74, 95% CI 1.44-2.16), but with significant increased risk of disability only over a 3-year follow-up (HR 1.32, 95% CI 1.06-1.86 over a 3-year follow-up and HR 1.16, 95% CI 0.88-1.56 over a 7-year follow-up). Frail demented patients were at higher risk of all-cause mortality over 3-(HR 3.33, 95% CI 1.28-8.29) and 7-year follow-up periods (HR 1.89, 95% CI 1.10-3.44), but not of disability. Frailty syndrome was a short-term predictor of disability in nondemented older subjects and short-and long-term predictor of all-cause mortality in nondemented and demented patients.

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Section: Discussionmentioning

confidence: 97%

Frailty syndrome and all-cause mortality in demented patients: the Italian Longitudinal Study on Aging

Solfrizzi

Scafato

Frisardi

et al. 2011

AGE

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“…Recently, a Multidimensional Prognostic Index (MPI) for 1-year all-cause mortality, based on a Comprehensive Geriatric Assessment (CGA) with information on clinical, functional, cognitive, nutritional, social status, and drug use, was developed and validated in two different cohorts of hospitalized older patients. 15 Further studies demonstrated that the MPI score was an accurate predictor of all-cause mortality in older patients with several acute and chronic diseases, [16][17][18][19] including CKD. 20 At present it is unknown, however, whether the MPI may improve the predictive accuracy of the eGFR in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Addition of the Multidimensional Prognostic Index to the Estimated Glomerular Filtration Rate Improves Prediction of Long-Term All-Cause Mortality in Older Patients with Chronic Kidney Disease

Pilotto

Sancarlo

Aucella

et al. 2012

Rejuvenation Research

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Current prognostic scores of chronic kidney disease (CKD) are not accurate in older patients. The aim of this study was to evaluate the prognostic accuracy of the Multidimensional Prognostic Index (MPI) in comparison with and in addition to the estimated glomerular filtration rate (eGFR) to predict long-term all-cause mortality in hospitalized older patients with CKD. In a prospective cohort study with a mean follow-up of 2 years, we calculated eGFR according to the Modification of Diet in Renal Disease study and collected information on functional, cognitive, nutritional, co-morbidities, drug use, and co-habitation status to calculate the MPI on 1,198 patients aged ‡ 65 years with a diagnosis of CKD from an hospital-based sample. The all-cause mortality incidence rate for 100 person-years was 18.3 (men 22.7 vs. women 15.3, p < 0.0001). Adding the MPI to the eGFR model significantly improved all-cause mortality prediction accuracy: The C-index increased from 0.579 to 0.648 ( p < 0.0001), with correct reclassification of 25.9% of patients (Net Reclassification Improvement [NRI], 0.259, p < 0.0001; Integrated Discrimination Improvement [IDI], 3.8%, p < 0.0001). The correct reclassification was higher in patients who did not die (259/741 patients, reclassification rate = 34.9%) than in patients who died (62/457 patients, reclassification rate = 13.6%). Conversely, adding the eGFR to the MPI model seems to improve prediction accuracy less consistently. In fact, the C-index increased, but not significantly (from 0.639 to 0.648, p = 0.444), with correct reclassification of 5.8% of patients (NRI, 0.058, p = 0.012; IDI, 0.009, p = 0.001), suggesting a small, although significant improvement. Adding MPI information to the eGFR markedly improved the prediction of 2-year all-cause mortality in older patients with CKD. A multidimensional evaluation for all-cause mortality risk prediction should be considered in older patients with CKD.

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“…MPI has been consistently related to short 17 and longterm mortality risk after hospital discharge in patients with a broad spectrum of specific diseases, including, but not limited to, pneumonia, 12 dementia, 13 congestive heart failure, 14 and kidney failure. 15 The results of the present work extend those of previous studies of this group, providing new insight into the potential clinical application of MPI assessment.…”

Section: Volpato Et Almentioning

confidence: 99%

“…10 CIRS, MNA, ESS), information of housing status, and number of medications prescribed were recategorized based on a tripartite hierarchy and a new score was assigned (0 = no problems/low burden; 0.5 = minor problems/intermediate burden; and 1 = major problems/major burden). The specific thresholds used to define the three hierarchic categories were reported elsewhere 13,16 and were based on either validated cutoffs (SPMSQ, MNA, EES, ADL, and IADL) or frequency of distribution in the previous validation study (for CIRS and number of medications10).…”

Section: The Mpimentioning

confidence: 99%

“…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%

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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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The Multidimensional Prognostic Index (MPI), Based on a Comprehensive Geriatric Assessment Predicts Short- and Long-Term Mortality in Hospitalized Older Patients with Dementia

Cited by 76 publications

References 39 publications

Frailty syndrome and all-cause mortality in demented patients: the Italian Longitudinal Study on Aging

Frailty syndrome and all-cause mortality in demented patients: the Italian Longitudinal Study on Aging

Addition of the Multidimensional Prognostic Index to the Estimated Glomerular Filtration Rate Improves Prediction of Long-Term All-Cause Mortality in Older Patients with Chronic Kidney Disease

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

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