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RESEARCH PRODUCT
The multidimensional prognostic index (MPI) for the prognostic stratification of older inpatients with COVID-19: A multicenter prospective observational cohort study
A. PilottoM. AzziniA. CellaG. CenderelloA. CastagnaA. PilottoR. CustureriS. DiniS. T. FarinellaG. RuotoloA. PadovaniC. CustoderoN. VeroneseItalian Geriatric Society Hospital And Community (Sigot) Study Groupsubject
Comprehensive geriatric assessment; COVID-19; Frailty; Intensive care unit; Mortality; Multidimensional prognostic index; Prognosis; Aged; Aged 80 and over; Female; Geriatric Assessment; Humans; Italy; Male; Prognosis; Prospective Studies; SARS-CoV-2; COVID-19; InpatientsMaleAgingmedicine.medical_specialtyHealth (social science)Coronavirus disease 2019 (COVID-19)Comprehensive geriatric assessmentintensive care unitArticlePrognostic stratificationlaw.inventionCOVID-19 Multidimensional prognostic index Mortality Intensive care unit Prognosis Frailty Comprehensive geriatric assessment03 medical and health sciences0302 clinical medicinelaw80 and overHumansMedicineProspective Studies030212 general & internal medicineProspective cohort studyGeriatric AssessmentAgedAged 80 and overInpatientsFrailty030214 geriatricsSARS-CoV-2business.industryHazard ratioArea under the curveCOVID-19mortalityIntensive care unitmultidimensional prognostic indexConfidence intervalItalyEmergency medicineFemaleprognosisGeriatrics and GerontologybusinessGerontologyCohort studydescription
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. © 2021 Elsevier B.V.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-01-01 |