title: Multidimensional Prognostic Index predicts mortality and length of stay during hospitalization in the older patients: a multicenter prospective study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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]).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medical Sciences, University of Ferrara, Italy. vlt@unife.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Volpato
authors.affiliation: Geriatrics Unit, Azienda ULSS 16 Padova, Italy. Geriatric-Gerontology Research Unit and.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Bazzano
authors.affiliation: Unit of Biostatistics, Scientific Institute for Research and Care, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fontana
authors.affiliation: Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland.
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.affiliation: Geriatrics Unit, Azienda ULSS 16 Padova, Italy. Geriatric-Gerontology Research Unit and.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pilotto
mesh_terms: D000208:Acute Disease / Q000401:mortality*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000401:mortality*; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment
keywords: Aging.; Hospital; MPI; Mortality; Prognosis