The multidimensional prognostic index (MPI) for the prognostic stratification of older inpatients with COVID-19: A multicenter prospective observational cohort study.
COVID-19
Comprehensive geriatric assessment
Frailty
Intensive care unit
Mortality
Multidimensional prognostic index
Prognosis
Journal
Archives of gerontology and geriatrics
ISSN: 1872-6976
Titre abrégé: Arch Gerontol Geriatr
Pays: Netherlands
ID NLM: 8214379
Informations de publication
Date de publication:
Historique:
received:
10
03
2021
revised:
28
03
2021
accepted:
02
04
2021
pubmed:
22
4
2021
medline:
5
6
2021
entrez:
21
4
2021
Statut:
ppublish
Résumé
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. 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. 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). 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 33882420
pii: S0167-4943(21)00077-7
doi: 10.1016/j.archger.2021.104415
pmc: PMC8020604
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
104415Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.
Références
Sci Rep. 2020 Nov 13;10(1):19765
pubmed: 33188232
JAMA Intern Med. 2021 Apr 1;181(4):439-448
pubmed: 33394006
J Gerontol A Biol Sci Med Sci. 2019 Sep 15;74(10):1643-1649
pubmed: 30329033
Arch Gerontol Geriatr. 2021 May-Jun;94:104327
pubmed: 33485005
Can Geriatr J. 2020 Sep 01;23(3):210-215
pubmed: 32904824
Gerontologist. 1970 Spring;10(1):20-30
pubmed: 5420677
JAMA. 2012 Jan 11;307(2):182-92
pubmed: 22235089
J Am Med Dir Assoc. 2020 Jul;21(7):928-932.e1
pubmed: 32674821
JAMA. 2020 May 12;323(18):1775-1776
pubmed: 32203977
J Infect. 2020 Dec;81(6):944-951
pubmed: 33002560
Age Ageing. 2014 Jul;43(4):496-502
pubmed: 24590568
J Am Geriatr Soc. 2020 Jun;68(6):E30-E32
pubmed: 32359076
Lancet. 2019 Oct 12;394(10206):1376-1386
pubmed: 31609229
Intensive Care Med. 2020 Aug;46(8):1634-1636
pubmed: 32451583
J Am Geriatr Soc. 1975 Oct;23(10):433-41
pubmed: 1159263
J Gerontol A Biol Sci Med Sci. 2015 Mar;70(3):325-31
pubmed: 25209253
BMC Geriatr. 2021 Mar 17;21(1):186
pubmed: 33731018
Arch Gerontol Geriatr. 2021 Mar-Apr;93:104324
pubmed: 33352430
J Am Geriatr Soc. 1968 May;16(5):622-6
pubmed: 5646906
Age Ageing. 2020 Jul 1;49(4):499-500
pubmed: 32374368
Gerontologist. 1969 Autumn;9(3):179-86
pubmed: 5349366
BMJ. 2020 Mar 23;368:m1164
pubmed: 32205399
Rejuvenation Res. 2008 Feb;11(1):151-61
pubmed: 18173367
Lancet Public Health. 2020 Aug;5(8):e444-e451
pubmed: 32619408
Mon Bull Minist Health Public Health Lab Serv. 1966 Nov;25:238-68
pubmed: 6013600
Dement Geriatr Cogn Dis Extra. 2019 Jun 21;9(2):236-249
pubmed: 31303870
Nestle Nutr Workshop Ser Clin Perform Programme. 1999;1:3-11; discussion 11-2
pubmed: 11490593
Ann Intern Med. 2020 Nov 3;173(9):762-763
pubmed: 32698604
Ann Surg. 2017 Dec;266(6):1084-1090
pubmed: 27655240
Clin Interv Aging. 2016 Jan 18;11:55-63
pubmed: 26848261
J Clin Epidemiol. 2008 Apr;61(4):344-9
pubmed: 18313558
Aging Clin Exp Res. 2018 Apr;30(4):359-366
pubmed: 28510786
Ageing Res Rev. 2020 Jul;60:101047
pubmed: 32171786
Crit Care. 2020 Jun 9;24(1):321
pubmed: 32517776