Multidimensional Prognostic Index Predicts Mortality and Length of Stay During Hospitalization in the Older Patients: A Multicenter Prospective Study
Open Access
- 9 September 2014
- journal article
- research article
- Published by Oxford University Press (OUP) in The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences
- Vol. 70 (3), 325-331
- https://doi.org/10.1093/gerona/glu167
Abstract
The Multidimensional Prognostic Index (MPI) is a validated predictive tool for long-term mortality based on information collected in a standardized Comprehensive Geriatric Assessment. We investigated whether the MPI is an effective predictor of intrahospital mortality and length of hospital stay after admission to acute geriatric wards. Prospective study of 1,178 older patients (702 women and 476 men, 85.0±6.8 years) admitted to 20 geriatrics units. Within 48 hours from admission, the MPI, according to an earlier validated algorithm, was calculated. 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 earlier established cut-offs. Associations with in-hospital mortality and length of stay were examined using multivariable Cox regression models and adjusted Poisson linear mixed-effects models, respectively. At admission, 23.6% subjects had a MPI-1 score, 33.8% had a MPI-2 score, and 42.6% had a MPI-3 score. Subjects with higher MPI score at admission were older (p < .001), more frequently women (p < .001) and had higher prevalence of common chronic conditions. After adjustment for age, gender, and diseases, patients included in the MPI-2 and MPI-3 groups had a significantly higher risk for intrahospital mortality (hazard ratio: 3.48, 95% confidence intervals: 1.02–11.88, p = .047; hazard ratio: 8.31, 95% confidence intervals: 2.54–27.19, p < .001) than patients included in the MPI-1 group, respectively. In multivariable model, length of stay significantly increased across the three MPI groups (11.29 [0.5], 13.73 [1.3], and 15.30 [1.4] days, respectively [p < .0001]). In older acute care inpatients, MPI score assessed at hospital admission is an independent predictor of in-hospital mortality and the length of hospital stay.Keywords
This publication has 35 references indexed in Scilit:
- Discharge planning from hospital to homePublished by Wiley ,2013
- Assessing Gait Speed in Acutely Ill Older Patients Admitted to an Acute Care for Elders Hospital UnitJAMA Internal Medicine, 2012
- The Central Role of Prognosis in Clinical Decision MakingJAMA, 2012
- On the C‐statistics for evaluating overall adequacy of risk prediction procedures with censored survival dataStatistics in Medicine, 2011
- Extensions of net reclassification improvement calculations to measure usefulness of new biomarkersStatistics in Medicine, 2010
- The Multidimensional Prognostic Index Predicts Short- and Long-Term Mortality in Hospitalized Geriatric Patients With PneumoniaThe Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 2009
- Development and Validation of a Multidimensional Prognostic Index for One-Year Mortality from Comprehensive Geriatric Assessment in Hospitalized Older PatientsRejuvenation Research, 2008
- Characteristics of Nondisabled Older Patients Developing New Disability Associated with Medical Illnesses and HospitalizationJournal of General Internal Medicine, 2007
- Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimationStatistics in Medicine, 2004
- Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily LivingThe Gerontologist, 1969