Can the Multidimensional Prognostic Index Improve the Identification of Older Hospitalized Patients with COVID-19 Likely to Benefit from Mechanical Ventilation? An Observational, Prospective, Multicenter Study.
COVID-19
Comprehensive Geriatric Assessment
Multidimensional Prognostic Index
mechanical ventilation
mortality
noninvasive ventilation
prognosis
Journal
Journal of the American Medical Directors Association
ISSN: 1538-9375
Titre abrégé: J Am Med Dir Assoc
Pays: United States
ID NLM: 100893243
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
received:
12
02
2022
revised:
13
06
2022
accepted:
25
06
2022
pubmed:
8
8
2022
medline:
14
9
2022
entrez:
7
8
2022
Statut:
ppublish
Résumé
Data on prognostic tools for indicating mechanical ventilation in older people with COVID-19 are still limited. The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from mechanical ventilation. Longitudinal, multicenter study. 502 older people hospitalized for COVID-19 in 10 European hospitals. MPI was calculated using 8 different domains typical of the CGA. A propensity score, Cox's regression analysis was used for assessing the impact of mechanical ventilation on rehospitalization/mortality for 90 days' follow-up, stratified by MPI = 0.50. The accuracy of MPI in predicting negative outcomes (ie, rehospitalization/mortality) was assessed using the area under the curve (AUC), and the discrimination with several indexes like the Net Reclassification Improvement (NRI) and the Integrated Discrimination Improvement (IDI). Among 502 older people hospitalized for COVID-19 (mean age: 80 years), 152 were treated with mechanical ventilation. In the propensity score analysis, during the 90-day follow-up period, there were 44 rehospitalizations and 95 deaths. Mechanical ventilation in patients with MPI values ≥ 0.50, indicating frailer participants, was associated with a higher risk of rehospitalization/mortality (hazard ratio 1.56, 95% CI 1.09-2.23), whereas in participants with MPI values < 0.50 this association was not significant. The accuracy of the model including age, sex, respiratory parameters, and MPI was good (AUC = 0.783) as confirmed by an NRI of 0.2756 (P < .001) and an IDI of 0.1858 (P < .001), suggesting a good discrimination of the model in predicting negative outcomes. MPI could be useful for better individualizing older people hospitalized by COVID-19 who could benefit from mechanical ventilation.
Identifiants
pubmed: 35934019
pii: S1525-8610(22)00495-9
doi: 10.1016/j.jamda.2022.06.023
pmc: PMC9247233
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1608.e1-1608.e8Investigateurs
Mario Barbagallo
(M)
Simone Dini
(S)
Naima Madlen Diesner
(NM)
Marilia Fernandes
(M)
Federica Gandolfo
(F)
Sara Garaboldi
(S)
Clarissa Musacchio
(C)
Andrea Pilotto
(A)
Lena Pickert
(L)
Silvia Podestà
(S)
Giovanni Ruotolo
(G)
Katiuscia Sciolè
(K)
Julia Schlotmann
(J)
Informations de copyright
Copyright © 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
Références
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
J Am Geriatr Soc. 1968 May;16(5):622-6
pubmed: 5646906
Intensive Care Med. 2001 Oct;27(10):1622-6
pubmed: 11685303
Pol Arch Intern Med. 2020 May 29;130(5):400-406
pubmed: 32356642
Am J Cardiol. 2016 Dec 1;118(11):1624-1630
pubmed: 27670793
Eur Respir J. 2021 Feb 17;57(2):
pubmed: 33303538
Age Ageing. 2014 Jul;43(4):496-502
pubmed: 24590568
Medicine (Baltimore). 2020 Sep 18;99(38):e21970
pubmed: 32957315
Ageing Res Rev. 2020 Jul;60:101047
pubmed: 32171786
J Am Geriatr Soc. 1975 Oct;23(10):433-41
pubmed: 1159263
JAMA. 2012 Jan 11;307(2):199-200
pubmed: 22235093
Anaesth Crit Care Pain Med. 2020 Oct;39(5):549-550
pubmed: 32860987
Clin Nutr. 2020 May;39(5):1608-1612
pubmed: 31378515
Sci Rep. 2020 Nov 13;10(1):19765
pubmed: 33188232
Aging (Albany NY). 2020 May 29;12(10):9959-9981
pubmed: 32470948
Heart Lung Vessel. 2015;7(4):297-303
pubmed: 26811835
Stat Med. 2008 Jan 30;27(2):157-72; discussion 207-12
pubmed: 17569110
J Gerontol A Biol Sci Med Sci. 2015 Mar;70(3):325-31
pubmed: 25209253
Gerontologist. 1969 Autumn;9(3):179-86
pubmed: 5349366
Circ Heart Fail. 2010 Jan;3(1):14-20
pubmed: 19850698
Rejuvenation Res. 2008 Feb;11(1):151-61
pubmed: 18173367
J Am Med Dir Assoc. 2017 Feb 1;18(2):192.e1-192.e11
pubmed: 28049616
Eur Geriatr Med. 2021 Dec;12(6):1147-1157
pubmed: 34118057
Mon Bull Minist Health Public Health Lab Serv. 1966 Nov;25:238-68
pubmed: 6013600
PLoS One. 2015 Jun 25;10(6):e0130946
pubmed: 26110884
Rejuvenation Res. 2012 Feb;15(1):82-8
pubmed: 22352434
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
BMJ. 2020 Apr 7;369:m1328
pubmed: 32265220
Gerontologist. 1970 Spring;10(1):20-30
pubmed: 5420677
Arch Gerontol Geriatr. 2021 Jul-Aug;95:104415
pubmed: 33882420
JAMA. 2012 Jan 11;307(2):182-92
pubmed: 22235089
Aging Clin Exp Res. 2018 Feb;30(2):193-197
pubmed: 28417242
J Clin Epidemiol. 2008 Apr;61(4):344-9
pubmed: 18313558
Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818-24
pubmed: 7509706
Biom J. 2005 Aug;47(4):458-72
pubmed: 16161804
BMJ. 2020 Apr 14;369:m1464
pubmed: 32291266
Aging Clin Exp Res. 2021 Jun;33(6):1745-1751
pubmed: 33893989
Age Ageing. 2020 Jul 1;49(4):501-515
pubmed: 32377677
J Infect Dev Ctries. 2021 Mar 31;15(3):353-359
pubmed: 33839709
Aging Clin Exp Res. 2021 Jul;33(7):1875-1883
pubmed: 33001403
Eur Geriatr Med. 2021 Apr;12(2):223-226
pubmed: 33620704
Can Geriatr J. 2020 Mar 01;23(1):152-154
pubmed: 32550953