The multidimensional prognostic index (MPI) for the prognostic stratification of older inpatients with COVID-19: A multicenter prospective observational cohort study

Abstract

Background The topic of prognosis in COVID-19 research may be important in adopting appropriate clinical decisions. Multidimensional prognostic index (MPI) is a frailty assessment tool widely used for stratifying prognosis in older people, but data regarding inpatients, affected by COVID-19, are not available. Objectives To evaluate whether MPI can predict in-hospital mortality and the admission to intensive care unit (ICU) in older inpatients hospitalized for COVID-19 infection. Methods In this longitudinal, Italian, multi-center study, older patients with COVID-19 were included. MPI was calculated using eight different domains typical of comprehensive geriatric assessment and categorized in three groups (MPI 1 ≤ 0.33, MPI 2 0.34–0.66, MPI 3 > 0.66). A multivariable Cox's regression analysis was used reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs). Results 227 older patients hospitalized for SARS-CoV-2 infection were enrolled (mean age: 80.5 years, 59% females). Inpatients in the MPI 3 were subjected less frequently than those in the MPI 1 to non-invasive ventilation (NIV). In the multivariable analysis, people in MPI 3 experienced a higher risk of in hospital mortality (HR = 6.30, 95%CI: 1.44–27.61), compared to MPI 1. The accuracy of MPI in predicting in hospital mortality was good (Area Under the Curve (AUC) = 0.76, 95%CI: 0.68–0.83). People in MPI 3 experienced a significant longer length of stay (LOS) in hospital compared to other participants. No association between MPI and ICU admission was found. Conclusions Frailty- as assessed by high MPI score - was associated with a significant higher risk of in-hospital mortality, longer LOS, and lower use NIV, whilst the association with ICU admission was not significant. These findings suggest that prognostic stratification by using the MPI could be useful in clinical decision making in older inpatients affected by COVID-19.

A rapid and feasible tool for clinical decision making in community-dwelling patients with COVID-19 and those admitted to emergency departments: the Braden-LDH-HorowITZ Assessment—BLITZ

“…The Braden scale addresses domains beyond-organ function and includes functional, cognitive and nutritional aspects that are typically known to influence patients’ trajectories during and after hospitalization [ 18 , 19 ]. Our observation is in line with recent studies showing a critical role of frailty and functional status in determining COVID-19-related trajectories [ 2 , 11 , 12 , 20 – 25 ].…”

“…This lack, mainly driven by the focus of existing stratification tools exclusively on chronological age, organ function and morbidity, hinders the effective triaging with advancing age. Indeed, there is mounting evidence that multidimensional frailty beyond chronological age and organ specific function is a major driver of outcomes and life trajectories after SARS-CoV-2 infection [ 2 , 11 ]. Accordingly, a number of scores and early warning prognostic tools [ 12 – 16 ] have been recently developed to determine the risk of death in the ED setting.…”

Multidimensional Prognostic Index and Mortality in Intermediate Care Facilities: A Retrospective Study

“…In particular, in nursing home residents, we have shown that higher MPI values indicate a higher risk of mortality, independently of the presence or not of COVID-19 and vice versa (i.e., COVID-19 increases the risk of mortality independently of MPI values) [13]. More recently, we have reported that in older patients hospitalized for COVID-19, MPI is useful for better stratifying the risk of mortality, whilst more data are needed for predicting the risk of ICU admission [25].…”

Clinical presentation and outcomes of COVID-19 in older hospitalised patients assessed by the record-based multidimensional prognostic index, a cross-sectional study

“…In a recent prospective study by Pilotto et al using bedside MPI, they also found that older patients with COVID-19 in MPI level 3 had a significant higher mortality rate than the patients in MPI level 1 [ 38 ]. Besides being a strong predictor of mortality in a Brazil cohort during the first COVID-19 wave, frailty assessment was found to provide extra prognostic information by capturing risk factors apart from known risk factors associated with age, co-morbidity and acute disease [ 39 ].…”

“…In our data, rMPI and CFS showed a fair and equal efficiency to predict 90-day mortality. Our rMPI accuracy in predicting 90-day mortality was as good as the bedside MPI in predicting in-hospital mortality in Pilotto's study [ 38 ]. Different settings may impact choice of frailty assessment tool as CFS takes a short time to complete, whereas bedside MPI is more time-consuming.…”